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Monday, March 24, 2008


Herniorrhaphy (hernioplasty, hernia repair) is a surgical procedure for correcting hernia. A hernia is a bulging of internal organs or tissues, which protrude through an abnormal opening in the muscle wall. Hernias can occur in the abdomen, groin, and at the site of a previous surgery.

Herniorraphy, or hernioplasty, is now often performed as an ambulatory, or "day surgery", procedure.

Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region; some popular techniques include the Lichtenstein repair (flat mesh patch placed on top of the defect), Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect). This operation is called a 'hernioplasty'. The meshes used are typically made from polypropylene or polyester, although some companies market Teflon meshes and partially absorbable meshes. The operation is typically performed under local anaesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond aspirin or paracetamol. Patients are encouraged to walk and move around immediately post-operatively, and can usually resume all their normal activities within a week or two of operation. Recurrence rates are very low - one percent or less, compared with over 10% for a tension repair.

In recent years, laparoscopic repair of inguinal hernia has emerged as an increasingly popular option. "Lap" repairs are also tension-free, although the mesh is placed within the preperitoneal space behind the defect as opposed to in or over it. It has no proven superiority to the open method other than a slightly lower post-operative pain score. Unlike the open method, laparoscopic surgery requires general anesthesia.

NICE examined data on laparoscopic and open hernia repair -- they concluded that there is no difference in cost, as the increased costs of operation are offset by the decreased recovery period. Recurrence rates are identical. However, they found that laparoscopic repair:

- results in a more rapid recovery and less pain in the first few days
- has less risk of wound infection, less bleeding and less swelling after surgery (seroma)
- less chronic pain

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