How do I choose a hernia surgeon?
This is so important! Research is key. Like in any profession, there are differences in ability and skill among surgeons. Factors like bedside manners and compassion are really powerful in the process of going through surgery but technical skills are just as important. Both have significant impact on a patient’s experience and outcomes. There are real differences between surgeons that often come from experience and volume of surgeries performed. Inguinal hernia surgery is typically straightforward, but only when a surgeon has a really good understanding of complex anatomy and experience in this area of the body1. The more cases a surgeon does and better understanding of multiple techniques, the broader the knowledge he or she has when operating in this area leading to better outcomes2-4.
Knowing that your surgeon sees and operates on a lot of patients with inguinal hernias is vital. Don’t be afraid to ask! Many high volume hernia surgeons participate in the Abdominal Core Health Quality Collaborative and have access to their quality data. Transparent sharing of quality data is a really great way to inform patients and many high volume surgeons are happy to share this information. Check out Boston Hernia’s quality data here. Only a few surgeons (Including Drs Fullington and Reinhorn) are verified by the ACHQC.
Another good source of information is online reviews. Sites like google.com, healthgrades.com, and vitals.com can offer some really meaningful insight into other patients’ experiences. Our ultimate goal is the very best experience for our patients – we are so proud of how well our patients do with hernia surgery and have compiled our patients’ testimonials from these sites here.
What’s the difference between a general surgeon and a hernia surgeon?
Hernia surgeons train as general surgeons before specializing in this field. The basic difference is in volume of surgery and experience in hernias. The evidence shows that patients do better when they have surgery with surgeons who do more of a certain type of surgery2-4. Additionally, surgeons who specialize in hernia surgery commonly participate in societies and educational exercises where hernia is the main subject – this allows for specialists to be at the cutting edge of medical and surgical care in this area.
Participation in quality collaboratives allows these high volume surgeons to study their outcomes and place their focus on the highest quality care. Over the last two decades, speciality fellowships were created for abdominal wall reconstruction (AWR) and there are over 100 surgeons who are now fellowship trained in that. Unfortunately, there are no formal fellowship programs for inguinal hernia surgery, so our surgeons at Boston Hernia have dedicated their lives to study, research, and refine this common but complex operation. We hope that in the future, specialized training opportunities in inguinal hernia surgery will exist.
General surgeons, on average, perform about 50 hernia surgeries a year. Boston Hernia surgeons perform 500 hernia surgeries a year. Most general surgeons have a “one size fits all” approach for inguinal hernia repair. They typically have a preferred approach that they recommend to most, if not all, patients. Boston Hernia surgeons are highly experienced in several different approaches to inguinal hernia repair and recommend the repair that is best for the patient based on their individual goals and needs. We feel that when care is tailored to the patient, rather than surgeon preference, we can achieve the best outcomes for each individual.
What are the treatment options for my inguinal hernia surgery?
There are dozens of surgical techniques for repairing hernias. There are dozens of medical device companies producing hundreds of types of meshes to use in inguinal hernia surgery.
An experienced, specialized hernia surgeon should be able to offer different approaches based on the type of hernia and your particular medical history. Almost all techniques for inguinal hernia repair fall into four basic categories:
- Suture (non-mesh) repair – Example: Shouldice repair
- Mesh repair between the layers of the muscle – Example: Lichtenstein repair
- Mesh repair under all the muscle layers using general anesthesia – Laparoscopic and robotic repairs
- Mesh repair under all the muscle layers using local anesthesia with sedation – Open preperitoneal repair – Our most commonly used approach at Boston Hernia
Recent international guidelines5 suggest that placing the mesh under the muscles is better than placing it between the muscle layers, and that using local anesthesia is better than general anesthesia for hernia surgery.
For most patients, Dr. Reinhorn and Dr. Fullington recommend placing mesh under the muscles using local anesthesia and sedation. This is a revolutionary approach that has moved beyond many of the common complications of other approaches, constituting the LEAST INVASIVE APPROACH to inguinal hernia repair. Patients have less overall risks, the lowest possible risk of recurrence of their hernia, less pain, quicker recovery, and better quality of life in recovery.
In some situations, they recommend a non-mesh repair which has been studied and shown to produce excellent outcomes in certain patients and can be a great alternative to a mesh repair.
We have created a video demonstrating the differences, as well as a full page explanation of techniques.
Is mesh safe in hernia surgery?
When repairing an inguinal hernia, mesh is placed within or behind the muscle layers and acts as a scaffold onto which your body builds a scar. This scar becomes the new strength layer in the area where the hernia exists and acts to prevent bulging in this area. There are risks in any type of hernia surgery, including both mesh and non-mesh repairs. When used by experienced surgeons, with care taken to prevent complications, mesh is absolutely safe. It allows for the quickest recovery, the least pain, the best quality of life in recovery, and the most long lasting repair.
References:
1. Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches. Reinhorn, M., Fullington, N., Agarwal, D., Olson, M.A., Ott, L., Canavan, A., Pate, B., Hubertus, M., Urquiza, A., Poulose, B. and Warren, J., 2022. Hernia, pp.1-12. https://link.springer.com/article/10.1007/s10029-022-02680-0
2. Aikoye A, Harilingam M, Khushal A. The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair. J Clin Diagn Res. 2015 Jun;9(6):PC15-6. doi: 10.7860/JCDR/2015/14094.6057. Epub 2015 Jun 1. PMID: 26266161; PMCID: PMC4525550.
3. Aquina CT, Kelly KN, Probst CP, Iannuzzi JC, Noyes K, Langstein HN, Monson JR, Fleming FJ. Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair. J Gastrointest Surg. 2015 Jan;19(1):100-10; discussion 110. doi: 10.1007/s11605-014-2627-9. Epub 2014 Aug 14. PMID: 25118644.
4. Holt, Pär Nordin, and Willem van der Linden. “Volume of Procedures and Risk of Recurrence after Repair of Groin Hernia: National Register Study.” BMJ: British Medical Journal 336, no. 7650 (2008): 934–37. http://www.jstor.org/stable/20509581.
5. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12. PMID: 29330835; PMCID: PMC5809582.