Treatment Options

The best and most practical option is a surgical repair. The use of a truss (a surgical belt) is not recommended as they frequently do more harm than good.

In all hernia operations, the aim is to return the protruding contents into the abdomen (“reducing the hernia”) followed by repair of the torn muscle.
When the defect in the muscle is relatively small, repair can be achieved by simple stitching in one or more layers. When the defect is larger, it is better to reinforce the damaged are using sheets of synthetic material called mesh.

Most meshes are made of surgical plastic or specially processed animal tissue. They do not dissolve but are gradually incorporated into the tissues and cannot be felt.

Traditional vs Keyhole surgery

Implantation of mesh can be achieved by more than one method. In the traditional (or “open”) operation, an incision is made over the hernia, which is deepened through the layers until the defect is identified. The mesh is then implanted and fixed in place with stitches or clips, following which the outer layers are closed. Keyhole (or “laparoscopic”) operations are usually performed by inserting a telescope inside the abdomen and placing the mesh over  the defect from the inside, again fixing the mesh with clips or stitches.
As the technology has evolved, most hernias are now amenable to laparoscopic repair. This even includes large incisional hernias.

“TEP” vs “TAP”

TEP and TAP are different laparoscopic methods of repairing inguinal (groin) hernias. In  a TAP repair, the telescope is placed inside the abdominal cavity. In a TEP repair, the telescope does not go inside the abdominal cavity but is slid between the layers of the abdominal wall. TEP has the advantage of less likelihood of damaging internal structures but is technically more challenging and cannot be performed when there has been previous surgery low down in the abdomen.

Which operation is best for me?

This will, of course, be discussed and advised in any consultation. Keyhole operations leave less of a scar and tend to result in a quicker return to normal activity. They are, however, more complicated and therefore, more prone to complications such as bleeding.

The operation may be performed under general ("asleep") or local ("awake") anaesthesia. General anaesthesia is to be preferred in most instances (and for all keyhole procedures) unless there is a specific medical contra-indication as it is more relaxing for both patient and surgeon. In order to have a general anaesthetic, your stomach must be completely empty for at least 6 hours prior to the time of operation (no food or drink).

Hernia operations take from 45 minutes to 1 hour to perform. At the end of the operation, local anaesthetic will be injected into the wound to minimize pain. Sometimes after groin hernia, this results in numbness or even weakness spreading down the leg which resolves after a few hours.



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