MINIMAL PAIN. NO GENERAL ANESTHESIA. FAST RECOVERY.

 

Dr. Michael Reinhorn and Dr. Nora Fullington have dedicated years to research with the goal of providing the best outcomes and quality of life for patients with hernias- because that's what matters most. Learn how the open preperitoneal inguinal hernia repair is different and why Boston Hernia chooses it.

IT JUST MAKES SENSE.

 

 

 

 

 

 

 

It's like patching up a tire; by placing mesh behind (posterior to) the abdominal wall, we ensure that the repair is durable and cohesive with the natural anatomy. In addition, this method avoids the delicate nerves of the groin that pose a common concern with standard repairs.

WHAT MAKES THE OPEN PREPERITONEAL REPAIR BETTER

 

  • We don’t use general anesthesia.
    • Instead, we sedate our patients and give them local anesthesia. This means you won't be awake during your surgery, but you'll feel more alert after, avoid the taxing effects of general anesthesia, and be ready to go home the same day.Citation 1-3
  • We use a research-backed technique for placing mesh.
    • We place the behind the abdominal wall muscles (unlike many surgeons). This is associated with many benefits, including a low recurrence rate and low risk of post-operative complications. Citations 4-14
  • We minimize invasiveness. 
    • We make a small incision just over the hernia site and close it with dissolvable stitches. Citations 12-14
  • You probably won’t need opioid medication for pain.
    • Because of the way we perform hernia surgery, your pain is likely to be mild and brief. More than 95% of our patients take only Tylenol and/or Advil to manage pain. Read more on our Opioid Reduction page. Citation 15
  • You can get back to full physical activity in as little as 2 weeks.
    • For most patients, we recommend 14 day pause from strenuous activity, followed by a progressive ramp-up into normal activities. Patients with desk jobs often return to work within just a few days. Citation 16
  • You won't need a catheter in your bladder - unlike laparoscopic or robotic surgery.
    • Almost 1 in 10 patients who have laparoscopic surgery get a catheter in their bladder after surgery. With the Open Preperitoneal repair, that won’t happen. Citation 17-20

ALTERNATIVE REPAIR TYPES

 

1. Suture-only repairs: There are various repair types that don't involve mesh, including the Shouldice repair.

2. Traditional open mesh repairs (Lichtenstein): Mesh is placed on the outside of the abdominal wall.

3. Laparoscopic or robotic repairs: Multiple small incisions are made for robotic equipment to enter the abdomen and place mesh inside of the abdominal wall, under general anesthesia. 

 

We believe in patient-centered care and know that when it comes to hernia surgery, not one size fits all. You can trust we will discuss the best options for you.

THE RESEARCH

1. Prakash D, Heskin L, Doherty S, Galvin R. Local anaesthesia versus spinal anaesthesia in inguinal hernia repair: a systematic review and meta-analysis. The Surgeon. 2017;15:47–57. doi: 10.1016/j.surge.2016.01.001. - DOI - PubMed

2. Balentine CJ, Meier J, Berger M, et al. Using local rather than general anesthesia for inguinal hernia repair is associated with shorter operative time and enhanced postoperative recovery. Am J Surg. 2021;221:902–907. doi: 10.1016/j.amjsurg.2020.08.024. - DOI - PMC - PubMed

3.Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343–403. doi: 10.1007/s10029-009-0529-7. - DOI - PMC - PubMed

4.Koning GG, Keus F, Koeslag L, et al. Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein’s method for inguinal hernia repair. Br J Surg. 2012;99:1365–1373. doi: 10.1002/bjs.8862. - DOI - PubMed

5.Sajid MS, Craciunas L, Singh KK, et al. Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep (Oxf) 2013;1:127–137. doi: 10.1093/gastro/got002. - DOI - PMC - PubMed

6.Van Nieuwenhove Y, Vansteenkiste F, Vierendeels T, Coenye K. Open, preperitoneal hernia repair with the kugel patch: a prospective, multicentre study of 450 repairs. Hernia. 2007;11:9–13. doi: 10.1007/s10029-006-0137-8

7.Nienhuijs S, Staal E, Keemers-Gels M, et al. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg. 2007;31:1751–1757. doi: 10.1007/s00268-007-9090-7

8.Saber A, Ellabban GM, Gad MA, Elsayem K. Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study. BMC Surg. 2012;12:22. doi: 10.1186/1471-2482-12-22

9.Aravind S, Baruah TD, Babu G. Lichtenstein repair vs open pre-peritoneal mesh repair for inguinal hernia a prospective comparative study. NIJS. 2018;9:715–720. doi: 10.21088/nijs.0976.4747.9618.4

10.Nyhus LM, Stevenson JKHH. Preperitoneal herniorrhaphy: a preliminary report in fifty patients. West J Surg Obstet. 1959;67:48–54

11.Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different? Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Martínez-López P, Fernandes N, Bel R, López-Cano M. Hernia. 2024 Aug;28(4):1355-1363. doi: 10.1007/s10029-024-03050-8. Epub 2024 May 4. PMID: 38704470 Free PMC article.

12.Reinhorn M, Fullington N, Agarwal D, Olson MA, Ott L, Canavan A, Pate B, Hubertus M, Urquiza A, Poulose B, Warren J. Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches. Hernia. 2023 Feb;27(1):93-104. doi: 10.1007/s10029-022-02680-0

13.Bharani T, Agarwal D, Fullington N, Ott L, Olson M, McClain D, Lima L, Poulose B, Warren J, Reinhorn M. Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair. Hernia 2024 https://doi.org/10.1007/s10029-023-02936-3

14.Improved patient‑reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10‑year ACHQC analysis. Divyansh Agarwal, Tina Bharani, Nora Fullington, Lauren Ott, Molly Olson, Benjamin Poulose, Jeremy Warren, Michael Reinhorn. Hernia, 2023. https://doi.org/10.1007/s10029-023-02852-6

15.Mylonas KS, Reinhorn M, Ott LR, Westfal ML, Masiakos PT. Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies. Surgery. 2017;162(5):1095–1100. doi: 10.1016/j.surg.2017.06.017

16.Reinhorn M, Dews T, Warren JA; Abdominal Core Health Quality Collaborative Opioid Task Force*. Utilization of a National Registry to influence opioid prescribing behavior after hernia repair. Hernia. 2022 Jun;26(3):847-853. doi: 10.1007/s10029-021-02495-5

17.Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg. 2006;191(3):381–385. doi: 10.1016/j.amjsurg.2005.10.042. - DOI - PubMed

18.Jensen P, Mikkelsen T, Kehlet H. Postherniorrhaphy urinary retention—effect of local, regional, and general anesthesia: a review. Reg Anesth Pain Med. 2002;27(6):612–617. doi: 10.1053/rapm.2002.37122. - DOI - PubMed

19.Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg. 2006;191(3):381–385. doi: 10.1016/j.amjsurg.2005.10.042

20.Jensen P, Mikkelsen T, Kehlet H. Postherniorrhaphy urinary retention—effect of local, regional, and general anesthesia: a review. Reg Anesth Pain Med. 2002;27(6):612–617. doi: 10.1053/rapm.2002.37122