II. Technique: Group 1 Open Anterior Repair

  1. Summary
    1. Inguinal Canal repaired without mesh prosthesis
  2. Procedure (under local, spinal, or general anesthesia)
    1. Bassini Technique
    2. McVay Technique
    3. Shouldice Technique

III. Technique: Group 2 Open Posterior Repair

  1. Summary
    1. Inguinal Canal reconstruction from inside
    2. Avoids scar tissue from prior surgeries
  2. Procedure (under spinal or general anesthesia)
    1. Iliopubic Tract Repair
    2. Nyhus Technique

IV. Technique: Group 3 Tension-Free Repair with Mesh

  1. Most common Hernia Repair procedure
    1. Preferred over laparoscopy for older, less healthy patients
  2. Summary
    1. Similar to Group 1 anterior repair
    2. Nonabsorbable synthetic mesh is used
    3. Allows for no pressure on surrounding fascia
    4. Recurrence rates <1% and good longterm safety data
      1. Recent study showed 4.9% recurrence
      2. Neumayer (2004) N Engl J Med 350:1819-27 [PubMed]
    5. No Sexual Dysfunction after repair
      1. Zieren (2001) Am J Surg 181:204-6 [PubMed]
  3. Procedure (under local, spinal, or general anesthesia)
    1. Lichenstein Technique
    2. Rutkow Technique

V. Technique: Group 4 Laparoscopic Repair

  1. Accounts for only 10% of Hernia Repairs in United States
    1. Performed for recurrent or bilateral Hernia Repairs
  2. Summary
    1. Similar to Posterior approach and uses mesh repair
    2. Faster return to work (especially heavy labor)
    3. Allows bilateral Hernia Repair simultaneously
    4. Avoids scar tissue from prior surgeries
    5. More expensive than other procedures
    6. Less post-operative pain
    7. Higher recurrence rate than with open mesh repair
      1. Recurrence: 10.1% (twice the open mesh repair rate)
      2. Neumayer (2004) N Engl J Med 350:1819-27 [PubMed]
  3. Procedure (under general anesthesia)
    1. Transabdominal Preperitoneal Approach (TAPP)
    2. Total Extraperitoneal Approach (TEP)
      1. Uses balloon to expand extraperitoneal space
      2. More technically challenging than TAPP

VI. Complications

  1. Complications of both Open and Laparoscopic Repair
    1. Hemorrhage or hematoma (including Ecchymosis at Scrotum and penis)
    2. Bowel or Bladder injury
    3. Urinary Retention
    4. Nerve transection
    5. Nerve entrapment
      1. Ilioinguinal Nerve Entrapment
      2. Genital branch of Genitofemoral Nerve entrapment
    6. Wound Infection
    7. Chronic Pain (5-12%)
      1. Related to nerve entrapment (including scarring), mesh contraction, Osteitis Pubis
    8. Recurrence (See below)
  2. Complications specific to Open Repair
    1. Testicular atrophy
    2. Vas deferens transection
    3. Scotal Ecchymosis
    4. Hydrocele
  3. Complications specific to Laparoscopic Repair
    1. Major vessel injury
    2. Urinary Retention
    3. Trocar site Hernia
    4. Small Bowel Obstruction

VII. Efficacy: Recurrence

  1. Timing of recurrence: 5 to 25 years after repair
  2. Rate of recurrence
    1. Inguinal Hernia recurrence: 5-8%
      1. Direct slightly higher recurrence then indirect
      2. Lower recurrence rate with tension-free mesh
    2. Recurence after recurrent Hernia Repair: 30%
  3. Risks of recurrence
    1. Longstanding large Hernia (poor tissue quality)
    2. Overly rapid return to daily activity after repair
    3. Incomplete surgical dissection
    4. Comorbid condition
      1. Obesity
      2. Corticosteroid use
      3. Chronic Obstructive Lung Disease

VIII. Management: Return to work (approximate times)

  1. Light duty (desk work) by 10 days
  2. Heavier duty work by 4 weeks depending on procedure and per surgeon's discretion

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Ontology: Herniorrhaphy (C0019328)

Definition (MSH) Surgical procedures undertaken to repair abnormal openings through which tissue or parts of organs can protrude or are already protruding.
Definition (MSHNOR) Kirurgiske prosedyrer som gjennomføres for å reparere unormale åpninger der vev eller deler av organer kan stikke ut eller stikker ut allerede.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D059685
ICD9 53
SnomedCT 50465008
Italian Riparazione di ernia, Riparazioni di ernia non specificate, Riparazione di ernia NAS, Erniorrafia, Ernioplastica, Riparazione dell'ernia
Dutch herniaherstel NAO, herniaherstel, herniareparaties
French Cure de hernie SAI, Herniorraphie, Réparation herniaire, Hernioplastie, Réparation de hernie, Cure de hernie, Réparations des hernies
German Hernienoperation NNB, Leistenbruchoperation, Hernienreparation, Herniorrhaphie, Hernioplastik, Hernienoperationen, Hernienoperation
Portuguese Reparação de hérnia NE, Herniorrafia, Correcção hernial, Reparação de hérnia
Spanish Reparación de hernia NEOM, Herniorrafia, herniorrafia, reparación de una hernia (procedimiento), reparación de una hernia, Cirugía herniaria, Reparación de hernia
Japanese ヘルニア修復, ヘルニア修復NOS, ヘルニアシュウフク, ヘルニアシュウフクNOS
English hernia repair (treatment), hernia repair, Hernia repair NOS, hernia repairs, herniorrhaphies, hernia repair procedure, herniorrhaphy, repair of hernia, Hernioplasties, Repairs, Hernia, Herniorrhaphies, Hernia Repair, Hernia Repairs, Repair, Hernia, Herniorrhaphy, Hernioplasty, Hernia repairs, Hernia repair, Hernia repair (procedure), Hernia repair, NOS, Herniorrhaphy, NOS, Repair of hernia
Czech Plastika kýly NOS, Plastika kýly, Plastiky kýl, hernioplastika, herniotomie, operace kýly, herniorafie, kýla - chirurgie
Hungarian Sérv rekonstrukciók, Hernia rekonstrukció k.m.n., Hernia rekonstrukció
Russian УШИВАНИЕ ГРЫЖЕВЫХ ВОРОТ, USHIVANIE GRYZHEVYKH VOROT, GERNIORAFIIA, ГЕРНИОРАФИЯ
Polish Leczenie operacyjne przepukliny, Herniorafia, Zabieg naprawczy przepukliny
Norwegian Brokkreparasjon, Hernieplastikk, Brokkoperasjon