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HerniorrhaphyAka: Hernioplasty, Rutkow Technique, Laparoscopic Hernia Repair, Hernia Repair, Bassini Technique, McVay Technique, Shouldice Technique, Iliopubic Tract Repair, Nyhus Technique, Lichenstein Technique

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  1. See Also
    1. Inguinal Hernia
  2. 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
  3. 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
  4. Technique: Group 3 Tension-Free Repair with Mesh
    1. 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
      5. No sexual dysfunction after repair
        1. Zieren (2001) Am J Surg 181:204
    2. Procedure (under local, spinal, or general anesthesia)
      1. Lichenstein Technique
      2. Rutkow Technique
  5. Technique: Group 4 Laparoscopic Repair
    1. 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
    2. 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
  6. Complications
    1. Complications of both Open and Laparoscopic Repair
      1. Hemorrhage
      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. 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
  7. 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
  8. References
    1. Bax (1999) Am Fam Physician 59:143
    2. Flanagan (1984) Surg Clin North Am 64:257
    3. Lichtenstein (1993) Surg Clin North Am 73:529
    4. Liem (1997) N Engl J Med 336:1541
    5. Schumpelick (1994) Lancet 344:375

Hernia repair (C0019328)

ConceptsTherapeutic or Preventive Procedure (T061)
ICD953
EnglishHernia repair, Herniorrhaphy, Repair of hernia
Spanishherniorrafia, reparacion de una hernia
Parent ConceptsDigestive System Surgical Procedures (C0038898), Surgical repair (C0374711)
SourcesICD9CM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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