Surgical Methods
Inguinal Hernia Shouldice
This technique involves using tissue from the patients’ body in order to close the gap that was caused by the rupture. This surgical method has been used over the past decades and originates from the so-called Shouldice-Clinic in Canada. The posterior wall of the inguinal wall is strengthened plastically by two continuous sutures, which build up four rows of sutures altogether. Results are dependent on the size of the gap of the rupture. Small defects measuring less than 3 cm demonstrate an approx. 1.4 % chance of relapse /recurrence. Larger defects illustrate an approx. 3.5-5 % risk of relapsing.
Per Fix PlugR (Rutkow)
The use of the PerFix Plug was introduced at the start of the 80s by I. Rutkow from New Jersey in order to repair hernias during open surgery and is now the most common surgical method used in the USA. This method initially involves using the sub-lay technique to suture a plombage (plug) in form of an umbrella into the gap of the rupture and subsequently the insertion of a flat mesh into the inguinal canal. The rate of recurrence lies below 5 % and is thus considered as an excellent technique.
Lichtenstein
The surgical method developed by Lichtenstein from Los Angeles to repair hernias during open surgery was the most common technique used over the past years. The gap caused by the rupture is shut by way of an on-lay-plasty with the help of a synthetic mesh. Additionally this method can be combined with suturing the gap shut. The rate of recurrence lies below 5 % and is thus considered an excellent technique.
Infantile Inguinal Hernia
These types of hernias only require the protuberance of the peritoneum to be closed, because the abdominal wall is not defective. As a result this method can be carried out quickly and easily and is most commonly carried out on an out-patient basis.
Zimmermann/Marcy
If the patient suffers from a small lateral gap caused by the rupture, the posterior wall of the inguinal canal does not need to be reconstructed in its entirety. In most cases it is sufficient to strengthen the defective area with the patients’ own tissue. This type of hernia occurs most frequently in younger men.
Anaesthesia
The surgical methods listed above are all conducted either under full anaesthesia or by applying a local anaesthetic. In order to decide which type of anaesthesia is to be used, medical aspects, as well as the patient’s wishes and comfort have to be considered. Infantile surgeries are, however, always conducted under full anaesthesia.
Laparoscopic Surgery TAPP
If a laparoscopic hernia surgery is conducted, the use of a synthetic mesh is an absolute necessity. The patient is placed under full anaesthesia and the gap caused by the rupture is located under the abdominal wall during a laparoscopy. It is subsequently closed by a synthetic mesh. In theory the patient can also be operated on both sides of the body during one single operation. This, however, can only be conducted under full anaesthesia.
TEP
This method involves closing the defect in the abdominal wall by using a large synthetic net. The abdominal wall, however, is not opened up. Instead the video endoscopy is carried out in a layer between peritoneum und muscle.
Femoral hernia
This defect can be closed by gaining access either above or below the inguinal ligament. Under normal circumstances it is sufficient to conduct this operation by using the patient’s own tissue. Individual cases, however, require the use of synthetic material (mesh) in order to strengthen the abdominal wall. The latter can also be carried out during a laparoscopy.
Umbilical Hernia, epigastric rupture
The operation involves either closing the gap located at the navel or the abdominal centre line which was caused by the rupture. It is quite possible that over the years small parts of the peritoneum have grown into the gap created by the rupture. If the defect is less than 2 cm in size, it can be sutured shut. If the defect, however, is larger in size, the abdominal wall should be strengthened by a synthetic mesh in order to reduce the risk of a relapse.
Incisional Hernia
The patient’s tissue already suffers from a dysfunctional scar formation and thus repairing the defect with the patient’s own tissue does not provide a promising outlook onto the situation. It is only possible to achieve long-term stability by covering the gap, which was caused by the rupture, with a synthetic mesh. The net needs to overlap with the original scar by at least 5 cm in all directions, in order to avoid further ruptures in the future. Thus these operations can only be conducted under general or spinal anaesthesia.
Risks and undesirable after-effects resulting out of hernia operations:
Complications arising during hernia surgery are very rare: repetitive ruptures: less than 5 %; permanent nerve disruptions: less than 2 %, wound infection: less than 1%; damage to testicles: less than 1 %; thrombosis and embolism: less than 1 %; medicinal side effects and allergic reactions: less than 1 %; miction disruptions after local anaesthesia: 0.1%.
You can also find videos of actual surgeries under the video category in the main menu, containing the above described surgical procedures.
Further information regarding the above described surgical methods can also be found in the following brochures, which have kindly been made available to us by the BARD company.
PerFIX Plug Mesh
Inguinal Hernias
In order to download the pdf document (406 KB), please click on the image located on the right.
Ventralex Hernia Patch
Abdominal wall hernias, incisional hernias, umbilical hernias
In order to download the pdf document (368 KB) please click on the image located on the right.
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