Hernias generally result from degeneration of a supporting lining called fascia, located beneath the groin muscles. Once torn, the intestines push up to the skin surface giving rise to he characteristic bulge in the groin or swelling of the scrotum. Of all the different types of hernias, inguinal (groin) hernias are the most common. Men predominate with a 90% incidence while women account for about 10% of cases.
Inguinal hernias can present at all age groups from infants to seniors. Some common symptoms associated with a hernia include pressure, burning or stabbing pain in the groin and testicle pain. Hernias can never heal themselves, but instead continue to enlarge and cause more tissue damage and run the risk of a strangulation of the herniated tissue. Surgical repair is the only option to correct a hernia.
There are two methods to surgically repair hernias- the laparoscopic method (also known as minimally invasive) in which several small incisions are made to introduce special instruments into the abdomen and the open method (small incision in the groin). Both methods have their proponents, but the majority of hernias today are still repaired with the time honored open method.
With the open method a small incision is made in the groin and dissection is carried down to the hernia. The Lichtenstein, Mesh Plug and 3D Prolene System and Shouldice techniques are the most popular methods of repair. However, except for the Shouldice technique, which is a pure tissue repair, all other techniques require the insertion of mesh material.
The Shouldice repair takes about 20 to 30 minutes using a sedation (twilight) anesthesia. With the updated modification of the Shouldice method, Dr. Grischkan has achieved a failure rate less than 1% without the use of mesh. The other methods have reported higher failure rates and complications associated with the mesh. For patients with massive or prior failed hernia repairs, The Modified Shouldice method which incorporates a new type of mesh, has yielded unmatched success rates. Patients can typically resume activities as early as three days following the procedure.
The laparoscopic approach has gained popularity but suffers from several drawbacks. It must be performed under general anesthesia, takes significantly longer than an open repair and carries a higher risk of bowel, bladder or major vascular injuries. Moreover, this method requires the insertion of a very large piece of mesh to complete the repair. Studies comparing failure rates comparing laparoscopic repair with the Shouldice repair have demonstrated a significant advantage for the Shouldice approach.
Dr. Grischkan, our medical director, pioneered outpatient hernia surgery. He has lectured extensively both in the United States and Europe. He has published in this field and was a lead investigator for the development of a new mesh for hernia repairs. With over 20,000 hernia repairs performed, he is regarded as an authority on hernias.