A hernia is a mechanical problem and treatment involves a mechanical fix. A truss, a spring like device can control a hernia but is only rarely used and only then in patients who are so unfit to undergo surgical treatment, there really is no alternative. For the majority of patients presenting with a hernia, surgery is recommended.
Principles of Surgery
The principles of surgical treatment involve the reducing the hernia, removing any hernia sack, closing the defect and reinforcing the abdominal wall.
The majority of hernias are repaired by inserting a preformed polypropylene mesh. The mesh acts like a scaffolding allowing fibroblasts to be laid down. The fibroblasts then mature for a new strong layer which prevents hernia recurrence.
Using mesh repair the recurrence rate following standard inguinal hernia repair has been reduced from 10 % to under 1 %.
Involves making a large incision over the hernia, reducing the hernia sack, plicating the muscles over laying with the mesh and closing the skin. This technique still provides a very satisfactory repair.
This is an open surgical procedure carried out through a small incision over the hernia. The hernia sack can still be removed and a mesh inserted. The benefits of this technique are minimal scarring and a very rapid recovery.
Laparoscopic Hernia Repair
This is a true key-hole technique. It involves inserting small tubes into the anterior abdominal wall. The hernia is identified, the sack reduced and mesh applied to the inside of the hernial defect.
- Advantages – very rapid recovery, although it will still take 6 weeks to return to full activities.
- Disadvantages – increased incidence of recurrence, bleeding and problems with herniation at the port sites.
The true recurrence rate will depend on the site of the hernia, whether it is being repaired for the first, second or third time. Surgical recurrence rate range from 0.1% to 10%. For a new hernia, a hernia being repaired for the first time, the recurrence rate should be less than 1%.
A number of studies have shown that recurrence rate relates to the experience of the surgeon carrying out the procedure. Registrars in training are more likely to have a recurrence than a Consultant Surgeon with many years experience.
Complications following hernia surgery are rare, bruising is common, extensive bruising relatively rare although on occasions a large scrotal haematoma (bruise) can develop.
Infection is also rare. These are clean surgical procedures and unless carried out with another procedure rarely become infected. The surgical procedure involves admission into a surgical unit. Most hernias are repaired as a Day Case procedure. You will either require a light full anaesthetic or local anaesthesia. The procedure itself is painless. The post operative recovery is quick.
Although it takes 6 weeks until one can return to full activity most light activities can be resumed within a week. Driving a car within a week to 10 days. Returning to work (light activities) 1 to 2 weeks.