Inguinal hernia, commonly known as small bowel strings, is a common and frequent surgical condition. There are various surgical options for the treatment of inguinal hernia in China, but the overall choice is between two main categories, open and minimally invasive-lumpectomy. Both types of surgery have their advantages and disadvantages, and their application should be individualized to achieve the best results for the patient.
Open tension-free hernia repair
Open tension-free hernia repair was introduced to China from abroad in 1997 and then rapidly spread throughout the country. One of the major advantages of this tension-free hernia repair is the low recurrence rate, which has been below 2% in China, and in addition to this, the surgery can be done under local anesthesia. It usually requires only 2-3 days of hospitalization, and the procedure can even be completed on an outpatient basis. The commonly used open tension-free hernia repair methods in China are summarized as follows.
Flat-piece tension-free repair method (Lichtenstein procedure): Lichtenstein procedure involves suturing the patch to the wall of the inguinal canal and the spermatic cord is led out through the patch by punching a hole. It is recognized worldwide as the most classic procedure for hernia surgery and is currently the most widely used tension-free hernia repair procedure worldwide. It is currently a major surgical approach in the management of inguinal hernia because of its anterior approach to strengthen the posterior wall of the inguinal canal, simple access, superficial repair level and therefore few serious complications. However, this procedure has strict surgical protocols and points and requires a good formal training to achieve good results.
Tension-free hernia ring filling (Gilbert, mesh plug & patch): This procedure combines mesh plug filling (mesh plug, 1994) with the Lichtenstein procedure, in which the hernia ring defect is filled with polypropylene rolled into an umbrella shape, then the posterior wall of the inguinal canal is reinforced with a flat patch, and at one time the umbrella filling and the flat patch are not fixed, followed by It is a popular hernia repair procedure abroad and the most rapidly developing procedure in recent years. The operation is relatively simple, but postoperative recurrence has become the focus of attention and the recurrence rate is empirically high.
Kugel: This is a new tension-free hernia repair method proposed in 2000, in which a memory memory elastic ring patch (Kugel patch) made by Bard, USA, is placed in the anterior peritoneal space to repair the pubococcygeal muscle foramen. With the rapid development of synthetic material science, the patch material has reached the ideal requirement for the overall repair of the three potential defects of the internal ring, direct hernia triangle and femoral ring, which is the concept of total inguinal repair.
Currently, the open procedure in our department for inguinal hernia treatment is mostly anterior peritoneal space patch placement repair under local anesthesia, which is performed under local anesthesia and the patch is placed in the anterior peritoneal space with satisfactory results. This procedure is performed under local anesthesia and the patch is inserted into the anterior peritoneal space with satisfactory results. It is mainly indicated for elderly and frail patients or those with multiple co-morbidities
Minimally invasive – laparascopic repair of inginal hernia (laparoscopic repair of inguinal hernia).
The first laparoscopic inguinal hernia repair was performed by Ger in 1982 with success, and the clinical reports of this technique have gradually increased and diversified the repair modalities, bringing a new technique and showing great promise for inguinal hernia repair. Laparoscopic hernia repair is a minimally invasive technique developed on the basis of the joint development of lumpectomy and tension-free hernia repair, and is another successful procedure after the minimally invasive surgery of lumpectomy for biliary, colonic and gastric diseases.
The advantages of this method are as follows: minimally invasive, no large incisions, and freedom of movement from the ground after surgery. It is possible to solve the problem bilaterally in a single operation, and the exploration of the hernia prevents the risk of missed hernia and eliminates the risk of incision. The risk of infection is minimal. Tension-free hernia repair techniques use patches, and postoperative infection is most feared, but infection is extremely rare with minimally invasive techniques. Low recurrence, as surgeons with extensive experience in laparoscopic surgery can further reduce recurrence rates to 0.1%. Early return to work, especially for active workers who need to return to work or elderly people who like to exercise should prefer this procedure.
In addition, laparoscopic total extraperitoneal repair is most appropriate for bilateral inguinal hernias and recurrent hernias. This procedure has been accepted by more and more patients because of its advantages of less trauma, faster recovery, and lower recurrence, and because the gap between the cost of treatment and that of open artificial mesh repair is gradually narrowing, but total extraperitoneal hernia repair is technically challenging and requires a surgeon with extensive experience in laparoscopic surgery to perform this procedure.
There are two types of laparoscopic hernia repair procedures commonly used today.
One is the transabdominal TAPP procedure, which is safe and has extremely broad surgical indications, and can deal with conventional inguinal hernia and recurrent hernia, giant hernia, difficult-to-repeat hernia, etc. It is the most widely used and suitable for the Chinese situation because many hernia patients in China have been seen late and have a long medical history.
This method requires a higher level of skill, and the patient should not have a long medical history or a large hernia, and is suitable for patients with a short medical history and a small hernia. It must be performed by an experienced physician to ensure safety.
Both methods can achieve very good results and theoretically can cure inguinal hernias. I have personally treated more than 3,000 patients with a maximum follow-up of more than five years and the results are very satisfactory. Laparoscopic inguinal hernia surgery has now become one of the surgical procedures of choice for the routine treatment of hernias. The postoperative recovery is quick, with a return to work period of about 3 days.
Rational choice of surgical procedure
Both open and lumpectomy are currently internationally recognized treatments. The open procedure is simple and quick, and local anesthesia expands the indications for surgery and is an affordable option.
The laparoscopic procedure is minimally invasive, without large incisions and with little trauma. General anesthesia allows patients to have no intraoperative discomfort, with less postoperative pain and shorter return to work, and is currently the most advanced concept for radical inguinal hernia treatment. The choice of minimally invasive laparoscopic surgery requires a surgeon with good specialized training to perform it so as to ensure the efficacy.
Whether a patient with inguinal hernia is suitable for laparoscopic or open surgery, the surgeon should fully inform the patient of the respective risks and advantages of open and laparoscopic surgery and should be part of the surgical consent form, and the patient should make the choice based on his or her own situation and professional advice.