The Boston Hernia Approach to Inguinal Hernia Surgery 

There are many different ways to repair an inguinal hernia, but not all are created equal. At Boston Hernia, we offer the Advanced Open Preperitoneal Inguinal Hernia Repair, which allows for less pain and faster recovery after hernia surgery.

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.

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

HOW IT'S DONE

 

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.

THE ALTERNATIVES

In the video below, Dr. Reinhorn explains the anatomy involved in an inguinal hernia and the four main ways to repair an inguinal hernia.

1 - Suture only repair - various types including Shouldice repair

2 - Traditional open mesh repair - patch on the outside of the abdominal wall

3 - Laparoscopic or robotic inguinal hernia repair - patch on the inside of the abdominal wall under general anesthesia

4 - Advanced open preperitoneal hernia repair - patch on the inside of the abdominal wall under local with sedation (in most patients)