During hernia surgery, a harmless gas is pumped into the patient’s belly. The harmless gas expands the abdominal space, giving the surgeon more room to work. Other cuts are made, and the surgeon inserts tools to repair the hernia. After repairing the hernia, the scope is removed and the hernia is stitched. The procedure can be performed in less than one hour.
This type of hernia repair can only be performed under general anaesthesia. You will be asleep during the entire procedure. A surgeon will make three or four small incisions around your hernia, with one incision measuring less than an inch, and the others are smaller. A thin camera called a laparoscope is inserted through one of the incisions, and all the other surgical tools are inserted through the other incisions.
In the TAPP technique, the surgeon enters the preperitoneal space through a small incision made at the level of the umbilicus. Then, the surgeon creates a small opening through the medial umbilical ligament and inclines the peritoneal flap towards the anterior superior iliac spine. The patient is then sedated, and the peritoneal flap is closed. The mesh prosthetic covers the entire myopectineal orifice.
Before your surgery, your surgeon will ask you to complete consent forms. You will be required to change into a hospital gown. You will be asked to stop taking certain medications such as ibuprofen and aspirin, which may cause more bleeding. Also, your surgeon will probably prescribe you pain medication, so it’s important to have it filled before your surgery. This type of anesthesia allows surgeons to perform multiple hernias using a single incision.
Non-mesh suture repairs
There are several reasons why non-mesh suture repairs for hernoas are preferred. In these surgeries, the patient’s own tissue is stitched back together. These surgical methods differ in how they prevent hernias from recurring. Tension repairs place tension on the muscles surrounding the hernia, whereas tension-free procedures do not. The primary non-mesh repair technique is called the Shouldice repair. This method was first used in World War II, when recruits were reluctant to undergo mesh surgery.
While non-mesh hernia repairs eliminate the use of mesh, they are more painful and require longer recovery times. In addition, the possibility of recurrence of hernias is greater. However, this option is ideal for a first operation, if the patient can tolerate pain and a longer recovery time. If the hernia comes back, the surgeon may opt for a mesh repair.
One meta-analysis reported a recurrence rate of 8%, outside of specialized centers. Moreover, the study only included one study, which was prone to bias. Its results were in line with the current literature on the topic. However, the study found that hernia size is likely to be a confounder in the decision between mesh repair and non-mesh suture repair. The number of patients who underwent mesh or non-mesh hernia surgery is largely unrelated to hernia size, and this information may not have been reported uniformly in the studies.
Among hernia repair methods, Lichtenstein repair is the most common. This procedure is characterized by its use of tension-free mesh to bridge the defect and isolate the hernia from cord structures. It requires only minor incisions and a short hospital stay. This method can be a better choice for patients who experience pain and a foreign body sensation after the surgery. Its primary advantage is that it can be performed on an outpatient basis. The mesh is regrown into the body over a period of two to three weeks.
Although the Lichtenstein technique is not the only alternative for inguinal hernia repair, it is the most common surgical procedure for this condition. It is often the most effective and safest option for patients with hernias that are mild to moderate. It can be done by both general surgeons and junior surgeons. Some studies have shown that this technique can reduce the rate of postoperative chronic pain and recurrence, and it is the most common repair in the world.
A recent study showed that Lichtenstein repair performed under local anesthesia is as effective as the TEP under general anesthesia. The study included 60 male patients with unilateral inguinal hernias. The group that received local anesthesia experienced less intraoperative pain than the group that underwent spinal anesthesia. Patients with Lichtenstein repair had fewer postoperative complications compared with patients who received spinal anesthesia.