NO GENERAL ANESTHESIA. MINIMAL PAIN. EXCELLENT LONG-TERM OUTCOMES.

 

When patients come to our office, they have questions about their hernia surgery. And they are quick to ask: When will I be able to return to work? How quickly will I be able to exercise? How long before I can get back to all my regular activities?

They typically are surprised, and pleased, at how quickly we expect them to recover after we perform their hernia surgery. Why? Boston Hernia is rare in employing all the proven techniques that lead to a successful surgical outcome and a fast recovery.

 

Fast Recovery After Hernia Surgery: Everything We Do at Boston Hernia Helps You Get There

 

You may hear about laparoscopic and robotic surgery for hernia repair, but all the studies show that a small, open incision, which is what we use, leads to successful surgery and a faster recovery.

How fast? In a recent study of Boston Hernia’s patients, it was found that:

  • 40% of our patients missed no work.
  • Most returned to full activities within two weeks of their surgery.
  • Also, fewer than 1% of our patients developed a recurrence (where their surgery did not result in a permanent repair).

 

Here's How Open Preperitoneal Inguinal Hernia Surgery Leads to a Faster Recovery than the Standard Approach

 

  • 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.
  • 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 (1, 2, 3).
  • 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.
  • 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.
  • We minimize invasiveness. 
    • We make a small incision  just over the hernia site and close it with dissolvable stitches.

 

Continue reading below if interested in more detailed information about what we do differently

Technical Information on How We Perform Inguinal Hernia Surgery

 

There are many different ways to repair an inguinal hernia, but not all are created equal. To better understand the various repair types, we often compare the abdominal wall to a bicycle tire. An inguinal hernia is much like a hole in a bicycle tire with the inner tube sticking out. In order to fix the hole in the tire, you can stitch the hole closed, you can place a patch on the outside of the tire, or you can place a patch on the inside of the tire.

Basic physics tells us that a patch on the inside of the tire is the best way to fix the hole in the bike tire, as the pressure from the inner tube will hold the patch in place over time. The same principle applies for inguinal hernia repairs.

There are two ways to get a patch on the inside of the abdominal wall: open and laparoscopic.

  • Open surgery (Advanced Open Preperitoneal Inguinal Hernia Repair) entails a 1.5 inch incision in the groin and is most often performed under local anesthesia with sedation in most patients.
  • Laparoscopic surgery entails multiple (3-4) small incisions and is always performed under general anesthesia.

 

At Boston Hernia, we highly recommend the Advanced Open Preperitoneal Inguinal Hernia Repair, as patients can often avoid general anesthesia and typically have less pain post-operatively, when compared to laparoscopic inguinal hernia surgery.

 

Watch How Preperitoneal Inguinal Hernia Repair Works

A patch on the inside of the abdominal wall is the preferred repair type for the following reasons:

  • Patients’ abdominal pressure is working to keep the patch in place over time, leading to a lower risk of recurrence
  • The patch is placed away from nerves in the groin, leading to a lower risk of chronic groin pain
  • Recovery time is shorter, allowing patients to return to normal activity and exercise sooner
  • Post-operative pain is less, leading to much lower use of narcotics in the recovery period

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. 

 

THE RESEARCH

 

(1) Agarwal D, Bharani T, Fullington N, Ott L, Olson M, Poulose B, Warren J, Reinhorn M. Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis. Hernia. 2023 Oct;27(5):1139-1154. doi: 10.1007/s10029-023-02852-6. Epub 2023 Aug 8. PMID: 37553502; PMCID: PMC10533599.

(2) Koning, G.G., Andeweg, C.S., Keus, F. et al. The transrectus sheath preperitoneal mesh repair for inguinal hernia: technique, rationale, and results of the first 50 cases. Hernia 16, 295–299 (2012). https://doi.org/10.1007/s10029-011-0893-y

(3) Muhammad S. Sajid, L. Craciunas, K.K. Singh, P. Sains, M.K. Baig, Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials, Gastroenterology Report, Volume 1, Issue 2, September 2013, Pages 127–137, https://doi.org/10.1093/gastro/got002