Hernia is one of the most common diseases in general surgery, and once it develops, it cannot be cured by itself. Its incidence rate in the natural population is 3.6‰, and increases significantly with age, with the incidence rate above 60 years of age at about 11.3‰, with about 4-5 million people developing the disease in China every year. Take inguinal hernia as an example, early or less symptomatic people will feel local pain, lower abdominal cramping and indigestion. After the disease develops, the hernia may fall into the scrotum, which may cause inconvenience in movement and walking and decrease the quality of life. Adult hernia is not self-healing and surgery is the only feasible cure. When a hernia becomes ingrown and cannot be operated in time, fatal complications can often occur, especially in elderly patients with comorbidities. In severe cases, the hernia can be difficult to reset, resulting in intussusception, intestinal necrosis, and even life-threatening injuries.
There are currently two types of surgical approaches.
One type is the traditional hernia repair, i.e., suturing the abdominal wall weakness under tension, but this surgical method is highly traumatic, destroys many anatomical structures, easily damages nerves, and has heavy postoperative pain, prevents early activity, and has a high recurrence rate (10-15%).
The second type of method is the tension-free hernia repair, which is a new method different from the traditional surgery promoted at home and abroad in only 10 years. This method is to repair the defective area of the abdominal wall under tension-free with a medical special material that has been used internationally for nearly 40 years. The procedure is less traumatic and bleeding, with mild postoperative pain, 6 hours on the floor, short hospital stay, and a low recurrence rate (1-3%). Tension-free hernia repair is a new trend in hernia treatment, a procedure that has been widely performed in the United States and European countries in recent years, and is known as a milestone in hernia surgery. Nearly millions of people worldwide have already undergone this procedure.
Advantages of tension-free inguinal hernia repair
(1) Reduced recurrence rate of hernia.
(2) Less injury, less pain, and faster recovery.
(3) Broadening the indications for hernia surgery and simplifying the surgical procedure for hernia.
(4) Due to the poor stretchability of the mesh, it is not suitable for adolescents who are still growing and developing.
With the deepening of scholars’ understanding of inguinal hernia and the emergence of a wide variety of hernia patches, preperitoneal tension-free hernia repair with synthetic materials has become one of the most commonly performed repair procedures for the disease, and the recurrence rate of “hernia” has decreased significantly over the past hundred years from traditional hernia repair to tension-free hernia repair. Nowadays, with the development of hernia surgery, research on the pathogenesis of hernia and anatomy of inguinal canal, many scholars have proposed the concept of “pubococcygeal foramen”, which has led to the development of hernia repair from tension-free hernia repair to “anterior peritoneal hiatus hernia repair”, which has become a milestone in the treatment of hernia surgery with epoch-making significance and has reduced the postoperative recurrence rate of hernia repair from 10 It has reduced the recurrence rate of hernia repair from 10 % to less than 1%.
Compared with traditional hernia repair and tension-free hernia repair, anterior peritoneal hernia repair has obvious advantages: no need to expose the ligaments and excessive sutures required by traditional surgery, more in line with the local anatomy and physiology of the human body, enhanced repair of the whole inguinal region, comprehensive treatment of hiatal hernia, straight hernia, femoral hernia and recurrent hernia, firm postoperative healing, low recurrence rate, short operative time, fast recovery, low pain, and low postoperative foreign body recurrence. It has a strong postoperative healing, low recurrence rate, short operation time, quick recovery, light pain, and little postoperative foreign body sensation.
Causes of hernia recurrence.
(1) General factors.
① Age;
②Type of hernia;
(3) Type of hernia;
④Factors of smoking.
(2) Anatomical and physiological factors.
①Anatomical factors ;
②Physiological factors.
(3) Pathological factors: collagen metabolism disorder
(4) Material factors: material size, tension; crumpling, curling, displacement of material (poor fixation)
(5)Factors of medical origin
①Factors of the doctor
②Technical defects of repair
③ Defects in suture technique
(6) Factors of the repair method (traditional suture, Shouldice, mesh, filling, lumpectomy)