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What’s the best hernia repair?

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Q. My doctor has advised me to have my inguinal hernia repaired. Should I have a laparoscopic repair or the more traditional “open” procedure?

A. Inguinal hernias happen to almost a third of men. This type of hernia occurs when a portion of the intestines or the fatty tissue surrounding it bulges through a tear in the abdominal wall and into the groin or scrotum.

Surgery is the only lasting way to repair the weak spot and reduce bulging and pain. The method chosen for repair should take into account both your preferences and the surgeon’s experience and expertise.

Open repair continues to be the standard. It involves an incision in the groin region so the surgeon can see the area under repair. In contrast, the laparoscopic approach involves small incisions to allow the surgeon to pass a camera and instruments into the abdomen to repair the hernia. Although the smaller laparoscopic incision has a clear advantage for gallbladder surgery, the difference between laparoscopic and open repair in hernia surgery is not as great.

Comparison studies suggest that laparoscopic surgery reduces post-
surgery pain and allows a faster return to activities. Initial reports suggested that laparoscopic repairs led to more recurrences of the hernia, but that difference appears to diminish with a surgeon’s increasing experience. The rates of infection and other complications after the surgery appear to be the same. A person having hernias repaired on both sides of the groin may prefer the laparoscopic repair.

Discuss your concerns with the surgeon. What is the surgeon’s preferred method of repair and experience? Ask if you might be a better candidate for one type of repair or the other. Either way, the outcome of surgery is excellent in the vast majority of men, regardless of whether the repair is open or laparoscopic.

— William Kormos, M.D.
Editor in Chief, Harvard Men’s Health Watch

Posted by: Dr.Health

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