Hernia repair operations

Over 75% of all hernias occur in the groin, of which the vast majority are primary inguinal hernias. Primary inguinal hernia repair remains one of the most frequently performed operations in the United Kingdom.

Each year around 95,000 procedures are undertaken within National Health Service hospitals and 25,000 procedures within the private sector. Hernias affect both men and women and can occur at all ages from neonates to the elderly. However, they are most common in men aged between 20-65 years.
  

Usually, the suggested treatment is surgery. The old fashioned use of ‘truss-like’ devices is not now recommended. There are various surgical procedures used to repair hernias.
 

The 'mesh plug' repair technique was developed originally in the USA. It has been pioneered in the UK within the University Hernia Clinic, at St. Luke’s Hospital. 

The technique was first undertaken within the UK in 1997 and has proved very successful. As a result, it can now be offered as the treatment of choice to patients in The University Hernia Clinic at St Luke’s Hospital.

Increasingly, a mesh repair has been used as standard in the management of primary inguinal hernia. This involves inserting a piece of mesh to ‘reinforce’ the posterior wall of the inguinal canal. In the Lichtenstein procedure, the hernia is repaired by an anterior approach and the mesh is sutured into position. Suturing, however, causes some internal tissue tension which can be associated with post-operative discomfort and a slower recovery time.

The new 'mesh plug' technique involves making a small incision over the site of the hernia. The hernia is then reduced by returning the hernial sac into the abdominal cavity en masse. There is no need to excise the hernial sac. A piece of inert, shaped, sterile mesh is then inserted into the deep inguinal ring directly behind the weakened transversalis fascia. A second, onlay piece of mesh is used to ‘reinforce’ the area further. No permanent sutures are required at all, making the repair totally tension free. This surgical procedure takes around 25-30 minutes to perform as dissection is kept to an absolute minimum.

This 'mesh plug' repair represents, we feel, a significant advance over the Lichtenstein repair, conferring real benefits to the patient.

A recent prospective, randomised, controlled study1, comparing the mesh plug repair directly with the Lichtenstein repair, has shown the following results:

- less post-operative pain is experienced
- post-operative recovery and return to ‘normal’ activity is more rapid
- There were no observed differences between the methods concerning post-operative complications which were minimal. A published clinical paper by Barker SGE et al is available on request.1

A second study, recently undertaken at the Royal Gwent Hospital, Newport, would seem to confirm the above benefits.

The long term prospects for the mesh plug technique seem very good. In one USA institution, of 3091 primary inguinal hernia repairs carried out utilising the 'mesh plug' repair, only 22 people (<1%) experienced a recurrence at five years.3
 
 
  
References:
Barker SGE, et al. Primary inguinal hernia repair utilising the 'mesh plug' technique.
Ambulatory Surgery 2000; 8: 31-35.
Goyal S, Abbasakoor F, Stephenson BM. Experience with the preperitoneal ‘plug and patch’ inguinal hernia repair. British Journal of Surgery 1999; 86: 1284-1285.
Rutkow IM, Robbins AW. Mesh-plug hernia repair: a follow up report. Surgery 1995; 117: 597-598.