Hernia Repair: Overview of Hernia Treatment

Inguinal, or groin hernias, are among the most common of all hernias. While most common in men, approximately 10% of inguinal hernia patients are women. There are two approaches to inguinal hernia surgery. One is the laparoscopic method (also known as minimally invasive) and the other is the open method. Laparoscopic hernia surgery is done with general anesthesia using several small incisions through which a camera and instruments are inserted into the abdomen. The open method utilizes one incision under sedation anesthesia (no tube in throat and ventilator pumping gas into the lungs)) and the hernia is repaired under direct vision without entering the abdominal cavity where the vital organs reside. The most common open procedures include the Shouldice method, Lichtenstein repair, 3D Prolene System and the Mesh Plug technique. Unfortunately, all these methods of repair, except for the Shouldice method, require mesh for the repair and are associated with a high rate of chronic pain due to the presence of mesh.

Some drawbacks of the laparoscopic approach are the need for full general anesthesia and the use of extremely large segments of mesh for repair, requirement of a catheters into the bladder and a much longer operative time compared to open methods.

Studies have shown:

  • Laparoscopic repair has a significantly greater failure rate compared to Shouldice repairs.
  • Risks of life threatening complications such as bowel or bladder perforations are much more common with the laparoscopic repair.
  • Chronic post-operative pain is associated with the laparoscopic repair due to the use of mesh
Among the open methods of hernia repair, the Shouldice technique is the only one that repairs the patient’s tissue without the use of mesh. However, for a patient with a prior failed hernia repair or a massive hernia, the standard Shouldice method may fail due to the extent of damage to the groin tissue. The Modified Shouldice technique was developed by Dr. Grischkan for these patients by adding a small mesh to reinforce the tissue repair. In essence, every patient can now enjoy the benefits of a Shouldice repair at the Hernia Center of Ohio and expect a quick recovery with an exceptionally low risk of a recurrence.
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Entire Abdomen5%Fascia
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Upper Abdomen1%Fascia