OK, what Lee has is a 'pooching out' on both sides of his incision. The side that was 'mucked with' most in the reconstructive operation has the bigger 'pooch' (or intestinal fortitude, as we are calling it), and the other side has a good sized bulge or protrusion, too. From compiling the info given to us by the doc and from doing online searches, even though they didn't come right out and say 'double hernia' or tecnically 'bilateral incisional hernia', that's what Lee has. He really has TWO hernias, if you want to get technical. I read online that the main reason this happens after surgery there on and around the belly button, is because if you have constipation afterwards, the strain from that can be the cause- it weakens the abdominal muscles at the incision. Lee has had a lot of pain and constipation, so we've figured out the culprits. Also, if the pain intensifies and if the area turns red, then you are in danger of strangulation- the portion of the intestine going into the weakened or herniated region is being strangled, and will get useless and then gangrene will set in. The doctor told us in Lee's case there is no danger of that. He did tell us (less than this info) about that danger, but said Lee is safe. Here is some of what I 'grabbed' online - however, did not look at the info linked, for the most part. Oh, and I did see the one good result in all of this. Some VA hospitals have been participating in comparative outcome results between the tradition hernia operation, which has been a large opening and screen inserted, and the newer laparascopic procedure with a smaller screen inserted. If the hernia is a groin hernia, the results are better the traditional way, and there is more recurrence of hernia with the laparascopic routine. However, it's just the opposite with the hernia being at the region of the naval- but ONLY with this stipulation: if it's first time hernia surgery, it has to be a DOUBLE or BILATERAL hernia for the favorable benefits of the laparascopic procedure. In fact, I found online that the only times the laparascopic repair is beneficial is if there is a double hernia at the belly button region, or if it's repeat hernia surgery, with recurrence repair. Otherwise the traditional, with larger opening, is recommended. So this does put Lee in the category of the laparascopic technique being preferred, at least from the information I picked up online. What is good about this is there is  good chance he can have the surgery and either leave the same day or just spend one night in the hospital afterwards. Much less immediate pain afterwards. --WHO KNEW that TWO would be better than one, in the case of hernias, anyway?  Should we request a zipper this time? Nah, let's hope this is his last cut! --"Cheyenne Cin"-- P.S. Still anxious to get this done and over with, and not too happy about the wait in between- for safety reasons.

(EVEN THOUGH DOCTOR SAID IT's TOTALLY SAFE FOR HIM TO HAVE TO WAIT.) Also noticed on one 'non natural cures' related site that in the case of incisional hernias, lack of vitamin C is a contributor to problems! So bring out that VITAMIN C for those hernias, especially from the strain of constipation on an incisional hernia! (or 2)

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HERNIA INFORMATION

HERNIA INFORMATION

... Spigelian Hernia; Recurrent Hernia; Recurrent Incisional Hernia; Bilateral (or 'double') Hernia; Stoma Hernia; Hiatus Hernia. Although ... www.hernia.org/whatsport.html - 13k -

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LAPAROSCOPIC INGUINAL HERNIA REPAIR

Bilateral Incisional Hernia:

==========================

http://www.tiscali.co.uk/lifestyle/healthfitness/menshealth/part2_014-2.html

Incisional Hernia

Incisional hernias form through a weakness in the scar tissue formed after a previous operation, or area of trauma. Scar tissue is inelastic and stretches easily if put under constant strain ­ e.g. by lifting, chronic coughing or straining with constipation. It also becomes weaker with increasing age and if deficient in vitamin C. Complications after surgery such as wound infection or heavy bleeding also make scar tissue more likely to weaken.

Incisional hernias can be dissected and repaired surgically. If the patient is unfit for surgery, an abdominal belt (truss) is occasionally used.

Other symptoms of intestinal obstruction soon occur. These include vomiting, distension and bloating of the abdomen, noisy bowel sounds and absolute constipation. Not even wind can pass through the constricted hernia to be voided downwards. The hernia itself will feel tense and very tender. Overlying skin may become red, hot and inflamed in the later stages.

Figure 19: Hernia types. Inguinal, femoral, epigastric, umbilical and incisional hernias (in old operation scar) are the most common types.

A strangulated hernia is a surgical emergency. Even if strangulation is only suspected, medical advice should be sought without delay. If strangu-lation is not relieved urgently, so that blood circulation is restored, the loop of bowel will die and become gangrenous. This can cause life-threatening blood poisoning (septicaemia). The three commonest types of hernia to strangulate are, in order of frequency:

• femoral hernias

• indirect inguinal hernias

• umbilical hernias.

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http://pages.prodigy.net/replyasap/web/

On November 20, 1996 I thought I was Superman and lifted my lawnmower into the back of my Ford Explorer by myself ... mistake! The Christmas of 1996 I spent in misery ... I could hardly walk as the pain was on both sides of my groin (pain didn't manifest itself till three days after my super lift). I went to an internist on my medical plan and the first diagnosis was a direct hernia with two muscle pulls. The pain pretty much lasted a year and in that time I went to five surgeons ... all with the basic same diagnosis. Therein, lied my problem. I had an obvious visible bulge on my left side by could feel a bulge on my right side as well. All the specialists, including one that does only hernia repairs said I had just a single hernia ... but that there might be a "weakness" on the right side, but I knew better!! I only wanted to undergo ONE operation and not two separate operations. Besides, I didn't like the idea of two long 5 inch scars and the pain and suffering of two separate procedures. In that year period, I found out that 1) groin muscle pulls can last for a very, very long time ... not uncommon for them to last a year or more, 2) doctors don't usually diagnose "indirect" hernias, as there is no visible bulge or evidence, 3) hernias do not go away and only get worse with time and a surgical procedure is the only method of repair, 4) hernia repairs are the most common of general surgical operations. Let me tell the reader that I researched the Internet far and long for answers and found only a few personal hernia experiences (just a line or two), however, there are lots of sites that act as "advertising" for laparoscopic surgery and hernia repair. Therefore, I am adding my experience to the small list of those that underwent laparoscopic inguinal hernia repair and published their experience on the net. The difference is I have extensively given details that I would have wished I could have found in my search.

 

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THE RIGHT SURGEON

I met one surgeon who I thought was fantastic, but he was not schooled in the somewhat experimental aspect of laparoscopic hernia surgery. I had read on the internet extensively about the laparoscopic technique of hernia repair and knew it was to be performed only by someone who had done many of these procedures as it takes about fifty operations to master the learning curve ... unlike the typical non- tension method of repair. I felt from my research that the laparoscopic technique was less painful and I would recuperate in a shorter time. I knew the particular surgeon that I liked the most did not practice the laparoscopic technique and felt very comfortable in asking him who might be the right choice to perform the corrective operation. He suggested a surgeon who had done about five hundred such repairs. I contacted him and he said I had both a direct hernia and an indirect hernia and that he could repair both in a single operation lasting about an hour and be home the same day. Finally, a surgeon that said I had two hernias...where everyone else said I had just one hernia and a muscle pull. It was a long time since my original injury of over a year, but that was just what I wanted to hear!

Click above to learn about..

THE OPERATION

*It is strongly suggested that you finish reading the above hernia experience (the same links are at the end of the story). However, for those that do not wish to continue to the end, please see the links below as follows:

Links to Hernia Experiences

The Hernia Surgery Discussion Board with questions, answers and experiences for all kind of hernias. Hundred of thousands of posts have been made to this popular board. As of April 30, 2004, from the number of "hits" recorded, approximately 5-7% of all hernia patients operated on in the United States visit this board. We are not connected to any physician, or support any particular repair technique. I would be apprehensive of boards operated by physicians for personal gain. No monetary gain is received from this site.

The two hundred and seventy (386) hernia surgery experience comments made in the guestbooks on this site.

Hernia Surgery Experiences site with over 2500 guestbook entries submitted by people who accessed the site with their surgery experiences, questions and answers for all kinds of hernias.

 

The above posted entries are nonsolicited and are those of people like yourself who have visited the sites for pre and post hernia surgery questions and answers. We are overwhelmed by the quality of the posted entries and the desire for people to share their experiences with others. We know from hundreds of e-mails that many people have been helped or given peace of mind by other posted guestbook and discussion board entries. Our thanks goes out to all.

My operation performed Jan. 13, 1998

 

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Bilateral irreducible lumbar hernia
... showing the patient with bilateral irreducible lumbar ... as spontaneous or post traumatic
and postoperative incisional. Spontaneous hernia is usually a result of ...
www.edu.rcsed.ac.uk/Case%20Presentations/CP27.htm - 18k -

Inguinal hernia, Epigastric hernia, Femoral hernia, Incisional ...
... If the muscle gives way then an incisional hernia develops. ... of when someone says
they have a rupture or hernia. ... to one side or be present on both (bilateral). ...
www.thelondonherniaclinic.co.uk/hernia%20types.htm - 38k -

[PDF] LAPAROSCOPIC CHOLECYSTECTOMY ASSOCIATED WITH TREATEMENT OF HERNIA ...
File Format: PDF/Adobe Acrobat - View as HTML
... the diagnosis of chronic gallstone chole- cystitis, bulky subumbilical and unreductible
incisional hernia, total hysterectomy with bilateral adnexectomy on ...
facta.junis.ni.ac.yu/facta/mab/mab2000/mab2000-08.pdf - Similar pages

[PPT] Hernias
File Format: Microsoft Powerpoint 97 - View as HTML
... Indications. Recurrent hernia. Bilateral hernias. Must be able to tolerate general
anesthesia. ... Umbilical hernia. Incisional hernia. Abdominal Wall Anatomy. ...
www.cs.amedd.army.mil/ddl/ paslides/AbdominalWallHerniasWeb.ppt -

[PDF] Abdominal Wall Hernias Abdominal Wall Hernias
File Format: PDF/Adobe Acrobat - View as HTML
... Indications • Recurrent hernia • Bilateral hernias • Must be able to tolerate
general anesthesia ... Umbilical hernia Incisional hernia Page 37. ...
www.cs.amedd.army.mil/ddl/ paslides/AbdominalWallHerniasWeb.pdf -

Journal of Computer Assisted Tomography - Fulltext: Volume 23(1) ...
... One case involved bilateral incarcerated hernias at both trocar sites after a
laparoscopically ... This showed a right-sided incisional hernia of small bowel (Fig. ...
www.jcat.org/pt/re/jcat/ fulltext.00004728-199901000-00018.htm - 33k -

ICD-9-CM from code 550
... 553.03 Bilateral, recurrent. 553.1 Umbilical hernia: Parumbilical hernia. 553.2
Ventral hernia: 553.20 Ventral, unspecified; 553.21 Incisional: Hernia: postoperative ...
www.dmi.columbia.edu/hripcsak/icd9/1tabular550.html - 10k -

Hernia Repair: The Center for Diagnostic and Therapeutic ...
... and the site of a previous operation (called an incisional hernia). When hernias
occur on both sides of the groin, they are known as bilateral inguinal hernias ...
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Annals of Surgery - Fulltext: Volume 225(1) January 1997 p 63-68 ...
... The reported wound infection rate after bilateral adrenalectomy ranges from 4 ... significant
late complication in the anterior group was incisional hernia in 3 of ...
www.annalsofsurgery.com/pt/re/ annos/fulltext.00000658-199701000-00007.htm - 52k -

[PDF] Repair of incisional hernia with prolene hernia system
File Format: PDF/Adobe Acrobat - View as HTML
... report a new method in the repair of incisional hernia, using the prolene hernia
system ... at a near hospital, and a hernioplasty for bilateral inguinal hernia ...
medical.med.tokushima-u.ac.jp/ jmi/vol50/pdf/v50_n1-2_p108.pdf

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Subject: LAPAROSCOPIC HERNIA REPAIR-LAPAROSCOPIC vs. TRADITIONAL HERNIA REPAIR

 

http://www.sages.org/pi_hernia.html

 

PATIENT INFORMATION

FROM YOUR SURGEON & SAGES

LAPAROSCOPIC HERNIA REPAIR
ABOUT YOUR HERNIA AND LAPAROSCOPIC REPAIR:

Approximately 600,000 hernia repair operations are performed annually in the United States. Many are performed by the conventional "open" method. Some are performed laparoscopically. If your surgeon has recommended a laparoscopic repair, this brochure can help you understand what a hernia is and about the treatment.

LAPAROSCOPIC HERNIA REPAIR is a recent technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). It may offer quicker return to work and normal activities with decreased pain for some patients.

WHAT IS A HERNIA?

When a hernia occurs, it means the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.

Both men and women can get a hernia.

You may be born with a hernia (congenital) or develop one over time.

A hernia does not get better over time, nor will it go away by itself.

HOW DO I KNOW IF I HAVE A HERNIA?

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical) and the site of a previous operation (incisional).

It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements or during prolonged standing or sitting.

The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.

Severe, continuous pain, redness and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.

WHY DO PEOPLE GET HERNIAS?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can get a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

WHAT ARE THE TREATMENT OPTIONS?

• There are few options available for a patient who has a hernia.
• Use of a truss is rarely prescribed as it is usually ineffective.
• Most hernias require a surgical procedure.

Surgical procedures are now done in one of two fashions. I. The first, or traditional approach, is done from the outside through an incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic. II. The second approach is a laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a canula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.

Other canulas are inserted which allow your surgeon to work "inside." The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh or screen is fixed over the hernia defect and held in place with small surgical staples. 3 or 4 quarter inch incisions are usually necessary. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.

This technique may allow the patient to enjoy a shorter recovery time and experience less post-operative discomfort.

IS EVERYONE A CANDIDATE FOR LAPAROSCOPIC HERNIA REPAIR?

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or underlying medical conditions.

WHAT ARE THE COMPLICATIONS OF LAPAROSCOPIC HERNIA REPAIR?

• Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
• There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
• Difficulty urinating after surgery is not unusual and may require a temporary tube into the urinary bladder.
• Any time a hernia is repaired it can come back. This long-term recurrence rate is not yet known. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.

WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. Factors that may increase the possibility of converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.

WHAT PREPARATION IS REQUIRED?

• Most hernia operations are performed on an outpatient basis, meaning the patient will go home on the same day that the operation is performed.
• You should refrain from eating or drinking after midnight on the night before your operation.
• You should shower the night before or the morning of the operation.
• If you have difficulties moving your bowels, an enema or similar preparation should be used after consulting with your surgeon.
• Some preoperative testing may be required depending on your medical condition and the type of anesthesia needed for your operation.
• If you take medication on a daily basis, discuss this with your surgeon as (s)he may want you to take some of your medications on the morning of surgery with a sip of water. If you take aspirin, blood thinners or arthritis medication you need to discuss with your surgeon the proper timing of discontinuing these medications before your operation.

WHAT SHOULD I EXPECT AFTER SURGERY?

• Following the operation, you will be transferred to the recovery room where you will be monitored carefully until you are fully awake.
• Once you are awake and able to walk, you will be discharged.
• With any hernia operation, you can expect some soreness. This will be mostly during the first 24 to 48 hours.
• You are encouraged to be up and about the day after surgery.
• If you begin to have fever, chills, vomiting, are unable to urinate, or experience drainage from your incisions, you should call your surgeon immediately.
• With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, work and sexual intercourse.
• If you have prolonged soreness and are getting no relief from the prescribed pain medication, you should notify your surgeon. You should call and schedule a follow-up appointment within 2 weeks after you operation.

This brochure is not intended to take the place of your discussion with your surgeon about the need for a laparoscopic hernia repair. If you have any questions about your need for a hernia repair, your alternatives, the cost of the procedure, billing or insurance coverage, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the exam or subsequent follow-up, please discuss them with your surgeon before or after the operation.

This brochure was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), March 1997. It was prepared by SAGES Task Force on Patient Information.

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
(310) 437-0544
FAX: (310) 437-0585
E-Mail: sagesweb@...

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http://www.mayoclinic.com/invoke.cfm?id=HQ00980

Laparoscopic hernia repair: Is it right for you?

By Mayo Clinic staff

You're in the shower one morning when you notice a lump where your thigh meets your groin. When you push on the bulge, it moves inward. Chances are you've got a groin (inguinal) hernia — a condition that occurs when a section of intestine or a related structure pushes through weakened muscle or connective tissue. Some hernias are quite bothersome or painful. Others cause no symptoms. But most inguinal hernias require surgery to avoid possible complications, such as loss of blood supply to the protruding tissue. Repair of inguinal hernias is one of the most common surgical procedures in the United States, with 700,000 or more operations performed each year. Fifteen percent to 20 percent of these are done using laparoscopic techniques. Laparoscopic hernia repair involves inserting instruments through several small incisions in the abdomen to repair a hernia. This procedure may result in quicker recovery when compared with conventional surgery, which requires a larger incision. Laparoscopic surgery isn't for everyone, however. Learn more about this newer, less-invasive technique to help decide if it's the best surgical option for you.   Inguinal hernia: Protrusion through a weak point An inguinal hernia occurs when fatty tissue or part of the bowel or bladder moves outside of the abdomen through a weak point or tear in the lower abdominal wall. In some people, the abdominal wall weakness has been present since birth and doesn't cause problems until later in life. Other hernias occur because of muscle weakness or deterioration caused by factors such as aging, heavy lifting, strenuous physical activity or smoking. Though anyone can develop the problem, men account for 80 percent to 90 percent of all inguinal hernias. In men, hernias often develop in the region where the spermatic cord and blood vessels to the testicles exit the abdominal cavity and enter the scrotum. IMAGE Groin (inguinal) hernia In men, an inguinal hernia occurs when tissue — in this case a loop of ... << ENLARGE A hernia may cause tenderness and pressure or discomfort when you bend over, cough or strain. Your doctor can diagnose a hernia by feeling the area around the opening of the inguinal canal. A bulge in this area usually indicates a hernia. Even though an inguinal hernia isn't generally serious, doctors usually recommend surgery. Without it, complications are possible. Tissue or intestinal loops may protrude through the opening and become stuck (incarcerated). This requires surgery — sometimes on an emergency basis — to reposition the tissue and repair the defect. Incarceration may lead to strangulation, meaning that the blood supply to the protruding tissue is cut off. The result can be life-threatening gangrene of the bowel or bladder.   Laparoscopic hernia repair: Less invasive For traditional (open) hernia repair surgery, a surgeon makes an incision several inches long over the hernia and pushes any protruding tissue back to its proper place. Laparoscopic hernia repair, on the other hand, is typically less invasive and requires three small incisions — each no more than 1 centimeter long. During laparoscopic hernia repair, the surgeon inserts narrow, tube-like instruments through these incisions. One of the tubes has a tiny video camera attached that allows the surgeon to locate and view the hernia during the procedure. The other tubes provide access for surgical instruments needed for the repair. IMAGE Laparoscopic hernia repair In this technique, the surgeon inserts instruments through three small ... << ENLARGE To make the repair, the surgeon inserts a patch of synthetic mesh to cover the entire inguinal area, including all potential hernia openings. This provides reinforcement to weak areas in the groin that could result in future hernias. The surgeon then removes the instruments from the abdomen and uses a single stitch to close each of the small incisions. Laparoscopic hernia repair is usually an outpatient procedure, which means you can go home the day of your operation. Unlike traditional hernia repair, which uses local, spinal or general anesthesia, laparoscopic hernia repair requires general anesthesia. This means that you're given drugs that make you lose consciousness. You receive anesthesia drugs (anesthetics) intravenously, or you inhale them through a mask. They act as hypnotics, painkillers and muscle relaxants. Afterward, you won't remember the surgery. Your doctor will encourage you to move around after the procedure, and you can bathe or shower the following day. Because of the effects of general anesthesia, don't drive a vehicle for 24 hours after the surgery. Once you're home, you can resume routine activities — such as walking or light housework. And you may be able to return to work within a few days if your job involves only light activities. However, if your job requires more-strenuous activities or heavy lifting, your doctor may recommend that you wait one or two weeks before returning to work. After traditional hernia repair, you may have to wait three to four weeks to return to your regular activities.   Weighing the pros and cons Compared with traditional hernia surgery, laparoscopic repair can result in less discomfort following surgery and a quicker return to normal activities, according to David Farley, M.D., a general surgeon who coordinates training in laparoscopic procedures at Mayo Clinic, Rochester, Minn. "All in all, it seems to be less painful, and the recuperation time is shorter," says Dr. Farley. Dr. Farley also says that laparoscopic hernia repair may be your best surgical option if: You need repair of a recurrent hernia. The procedure is a good choice for people who have already had traditional hernia surgery, because laparoscopic methods allow surgeons to work around scar tissue from the previous repair. You need hernia repairs on both sides of your abdomen (bilateral hernias). Rather than making two separate incisions — one over each hernia — the surgeon can repair both hernias using the same three small incisions to insert the laparoscopic instruments. You need to return to work quickly. Laparoscopic repair usually requires less recovery time, so you can resume your regular activities more quickly. For example, after laparoscopic repair, you may be able to return to work within a few days. But after traditional hernia repair, you may have to wait several weeks. The chance of developing another hernia is low — about 1 percent — after a laparoscopic procedure if the surgeon uses synthetic mesh to reinforce the repair. This is similar to the recurrence rate after traditional hernia repair using mesh reinforcement. Although laparoscopic surgery has its advantages, it's not for everyone. Laparoscopic hernia repair may not be appropriate if: You have a large or incarcerated hernia You've had previous pelvic surgery such as a prostatectomy You can't tolerate general anesthesia In addition, laparoscopic surgery is more costly than traditional hernia repair and may take a few minutes longer to perform. It also may carry a greater risk of injury to blood vessels, nerves, bowel and bladder, but these complications are rare. As with open repairs, laparoscopic hernia surgery can cause temporary urinary retention — the inability to urinate — although this usually resolves spontaneously within hours. Because of these risks, choose a trained surgeon who has plenty of experience in laparoscopic hernia repair techniques. Discuss the pros and cons of the procedure with your doctor to decide if it's the right surgical option for you.

Related Information
Inguinal hernia Hernia exam: Why do I have to cough? Digestive Center

January 19, 2004

HQ00980

© 1998-2005 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.  A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. 

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RANDOMIZED TRIAL: LAPAROSCOPIC vs. TRADITIONAL HERNIA REPAIR

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Traditional Hernia Surgery Tops Laparoscopic Technique
Researchers report fewer recurrences and fewer complications

By Amanda Gardner
HealthDay Reporter

SUNDAY, April 25 (HealthDayNews) -- Traditional open mesh surgery is superior to laparoscopic surgery for most hernias, a new study reports.

The traditional surgery resulted in fewer recurrences and fewer complications, claims the study, which is to be presented April 25 at the spring meeting of the American College of Surgeons in Boston. The findings will also appear in the April 29 issue of the New England Journal of Medicine .

"The study establishes open hernia repair for a first-time hernia as a good choice for most patients. It is a very good procedure. It definitely should not be supplanted by laparoscopic surgery," said study chairman Dr. Leigh Neumayer, a staff surgeon at Salt Lake City Veterans Affairs Medical Center in Utah.

"There are particular patients for whom laparoscopic surgery might be as good or better," Neumayer added. These patients might include people who have already had hernia repair surgery or who have hernias on two sides.

Inguinal hernias occur when a portion of the intestine protrudes through the abdominal wall and into the groin area. The condition is extremely common and, according to an editorial in the same issue of the journal, more than 800,000 hernia operations were performed in the United States in 2003, most of them on an outpatient basis.

While there are different techniques to repair this type of problem, experts have struggled to determine which is best. Laparoscopic surgery involves making a tiny incision so as to insert tiny tools and cameras. This type requires general anesthesia and therefore more risk.

Open surgery requires a larger incision -- about 3 inches long -- and involves a slower recovery time but it can be done with local anesthesia.

In either case, surgeons use a plastic mesh to repair the wall of the abdomen and prevent the abdomen from bulging through. Previously, surgeons used to stitch the area up.

For this study, the researchers randomly assigned 1,696 men at 14 different VA medical centers to have either open mesh surgery or laparoscopic mesh surgery.

At the end of two years, men in the laparoscopic group had about double the recurrence rate as men in the open group: 10.1 percent vs. 4.9 percent. And the laparoscopic group had a 39 percent complication rate, compared with 33.4 percent for the open surgery group.

On the other hand, those in the laparoscopic group had less pain on the day of surgery and returned to normal activities one day earlier. These differences had resolved themselves by the end of three months.

Dr. Danny O. Jacobs, author of the editorial and chairman of the Department of Surgery at Duke University School of Medicine, wasn't surprised by the differences, only by the size of the differences.

"In surgery, we had been talking about these issues for years but we knew that laparoscopic surgery was technically challenging compared to removing a gall bladder," he said. "That it turned out as pronounced as it did appears a little surprising."

The anatomy in that region of the body does make laparoscopic surgery more complicated. "There are a number of other structures in the area that are potentially more likely to be injured than some other laparoscopic procedures," Jacobs said.

In a post-study analysis, the researchers also found differences in outcomes depending on how experienced the surgeon was. For the 58 surgeons who reported having performed 250 or fewer laparoscopic procedures of any type, the recurrence rate was 10 percent. For surgeons who had done more than 250 procedures, the recurrence rate was less than 5 percent.

"It looked like surgeons' experience had an impact. Whether it's truly that or something else, we can't say," Neumayer said. "That information has to be interpreted cautiously."

Still, for that reason and others, laparoscopic surgery is likely to take a back seat to open mesh surgery for repairing groin hernias.

"When you consider the issues about the level of experience required to get to that level of competence and the relatively good recurrence rates for open procedures, surgeons in many areas of country will never get to that type of number," Jacobs said. "We won't have many laparoscopic surgeries performed in this country."

More information

For more on hernias, visit the American Urological Association or the British Hernia Centre .

SOURCES: Leigh Neumayer, M.D., staff surgeon, Salt Lake City Veterans Affairs Medical Center, and associate professor, surgery, University of Utah School of Medicine; Danny O. Jacobs, M.D., professor and chairman, Department of Surgery, Duke University School of Medicine, Durham, N.C.; April 29, 2004, New England Journal of Medicine

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