Inguinal Hernia Repairs- Laparoscopic or Open?

Indirect inguinal hernia

Indirect inguinal hernia

By far the most common problem that I take care of in my practice is an inguinal (groin) hernia.

Patients often come in with a bulge and/or pain in the area of concern.  After I evaluate the patient and confirm the diagnosis, the discussion turns to whether the patient should have surgery and if so, what technique I use to repair the hernia(s).

The reasons to typically proceed with surgery include treating the symptoms that the hernia is causing and to minimize the future possibility of an organ/structure (namely a loop of small intestine) bulging through the hernia and getting twisted and stuck (incarceration).

This can lead to an intestinal obstruction and/or cut off the blood supply to that loop of intestine (strangulation).

Regarding technique, the field of General Surgery and I personally have come a long way.  When I first started private practice over 13 years ago, I mainly performed an Open Inguinal Hernia Repair.  This involved making an incision at the hernia site, dissecting down to the hernia, and inserting a piece of mesh to repair the hernia.  This technique does well to achieve the main goal, which is to fix the hernia.  However, patients often experienced significant pain, bruising, and swelling.  It typically took several weeks for them to return to work and resume their normal activities.  The overall recovery period was in the range of 4 to 8 weeks.

As is the case with many areas of surgery, there have been major advances in hernia surgery regarding techniques, equipment, and training.  I was having more and more patients asking about the laparoscopic technique (using a surgical camera and several small incisions) to repair their inguinal hernias.  More and more data showed that the technique was as safe as the open repair with equivalent results regarding the possibility of developing a recurrent hernia.  But with much less pain and a way shorter recovery period!  I made the decision in 2004 to go and learn the technique from several experts around the country and in the last 12 years, have repaired over a thousand inguinal hernias with the laparoscopic technique.  The patients have much less pain, bruising, and swelling.  They are able to gradually resume their normal activities, including work and exercise, without any formal restrictions.  The typical recovery period is 2-4 weeks, about half the time as with the open approach.

I try and stay up-to-date on current advances in the world of hernia surgery by reading surgical journals and attending specialty conferences and courses.  There is always something to learn from studies and recognized experts.  I recently learned and was disappointed to hear that only 20-25% of General Surgeons in the U.S. perform Laparoscopic Inguinal Hernia Repair as their primary option for inguinal hernia surgery.  The main reasons cited were a lack of familiarity/comfort with the anatomy and the time it takes to learn and master the laparoscopic technique.

With continued advances in equipment, techniques, and training, my hope is that more and more General Surgeons are able to offer this technique because I strongly feel that in the right hands, it is the ideal way to repair inguinal hernias.

—Rick Ngo, MD, FACS

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