The advanced open pre-peritoneal inguinal hernia repair that Dr. Reinhorn performs allows for faster hernia surgery recovery than many other types of inguinal hernia surgery. Patients report less pain in the postoperative period. Many patients return to normal activity within a few days of their hernia surgery and return to full physical activity within a couple of weeks of hernia surgery. Patients leave the hospital a couple hours after surgery to continue recovery from home. Most patients feel comfortable enough to be up and walking on the day of or the day after surgery. Many can return to work within 1-3 days after surgery, and return to full physical activity, including exercise, in 2 weeks. One of the other main advantages of this type of repair is a decreased risk of chronic pain that can sometimes be associated with inguinal hernia surgery. This repair is minimally invasive, and only requires one small incision in the groin about 1-1.5 inches in length.
Dr. Reinhorn’s Approach and Analysis of Inguinal Hernia Surgery
Not all inguinal hernia repairs are the same:
An inguinal hernia is much like a hole in a bicycle tire with the inner tube sticking out. To fix the tire, it’s best to get a patch under the hole, between the tire and the inner tube
There are 4 basic ways ( or combinations of some of the 4) that surgeons currently fix an inguinal hernia:
- Suture the hole in “the tire” using open technique under local anesthesia2
- Patch the hole using mesh on the outside of the “the tire” using open technique under local or general anesthesia
- Patch the hole in “the tire” using mesh from the inside between “the tire” and “the inner tube” using laparoscopic technique or robotic equipment and general anesthesia
- Patch the hole in “the tire” using mesh from the inside between “the tire” and “the inner tube” using open technique and local anesthesia with sedation
Basic physics and medical research suggest that placing a patch or mesh under the hole (#3 and 4) will give a better result. In addition, we find that doing this under local anesthesia with sedation (#4) leads to less post-operative pain and quicker recovery after surgery than laparoscopic repairs. Therefore, we offer the open pre-peritoneal repair (#4) as our first choice for a patient interested in a mesh repair.
Advanced Open Preperitoneal Inguinal Hernia Repair
This is approach number 4 described above. This is our preferred approach for inguinal hernia surgery. This is the repair we perform on 90% of our patients. After performing 500 laparoscopic inguinal hernia repairs in his first few years of practice, Dr. Reinhorn learned of this innovative approach and realized that patients recovered faster when having this repair than laparoscopic repair. While it seems counterintuitive that an open approach could result in better outcomes than laparoscopic surgery, we recently published our outcomes. Patient experience very little pain and a quick return to activity with this approach while having the safety associated with an open repair and avoiding general anesthesia.
This minimally invasive method for inguinal hernia surgery was first used in 1965 by Renee Stoppa, and refined by Robert Kugel in 1999. Using a small 1.25" incision, a thin mesh is placed under the abdominal wall in the same location as the laparoscopic repair. This repair has all the benefits of laparoscopic surgery, since the mesh is placed in the exact same location. At the same time, it has all of the advantages of open surgery in terms of safety and the ability to perform it under local anesthesia with sedation in selected patients. This combination allows for a faster recovery from hernia surgery as well as a lower incidence of chronic pain.
If you are interested in seeing a video of Dr. Reinhorn performing this procedure, please click here. You will be asked to create a free account in order to see the entire video.
Shouldice Inguinal hernia Repair
This is a non-mesh repair developed by the Shouldice Clinic in Toronto, Canada. Dr. Reinhorn offers this repair to a specific patient population, especially those patients who would prefer to avoid mesh. This repair involves suturing the defect in the abdominal wall back together in multiple different layers, which can be a great option for thin, healthy patients. The Shouldice Clinic provides expertise in this repair, and Dr. Reinhorn has visited the clinic to learn from their surgeons how to properly perform this repair. He has been offering this type of repair with increasing frequency over the last few years. If you are interested in more information, check our our Shouldice hernia page for more information about no mesh hernia surgery.
Traditional Approaches to Hernia Surgery
Dr. Reinhorn Explains the differences between the repairs with a schematic diagram.
About Dr. Reinhorn
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. Dr. Reinhorn started his practice as a full service general surgeon in 2001. In 2012 Dr. Reinhorn started to focus on the care of hernia and pilonidal patients. This focused practice has been designed to provide a superior clinical experience. Dr. Reinhorn has published his outcomes and continues to participate in hernia and surgery societies. His research led to a reduction in opioid prescribing after hernia surgery. His team performs approximately 400 hernia surgeries every year.