Inguinal (or groin) hernias are the most common type of hernia. Over 700,000 hernia repair operations are performed in this country every year, and 10% of these are emergency operations for intestinal incarceration.

Men are eight times more likely than women to get inguinal hernias, due to the anatomical differences they have as the spermatic cord passes through the abdominal wall. Some people are predisposed to getting hernias due to anatomical variances and connective tissue problems.

There are two types of inguinal hernias, indirect and direct. Indirect are the most common in men, women and children, and are caused by a congenital abnormality where the tract between the abdomen and the testicle does not close, this is called a patent processes vaginalis. Direct hernias result from tearing of the thin tissue of the inguinal floor (transversalis fascia).

Despite its prevalence and risk of complications, hernias are often regarded as trivial by both physicians and patients. In addition, many surgeons consider hernia repairs “intern cases”. However, the anatomy of the groin is very intricate and accurate dissection and identification of nerves is important in performing a good repair.

Furthermore, many surgeons are not aware of the sweeping changes that have been made in inguinal hernia repair in the last 10 years. Dr. Haggerty and Dr. Loris have made it a priority to become experts in several techniques of inguinal hernia repair as outlined below.

Several methods of repairing inguinal hernias have evolved throughout the years. The classic repair was described by Bassini in 1884. This involved approximating strong tissue on one side of the defect to the inguinal ligament on the other side. However, many times this resulted in excess tension, which led to recurrence of the hernia. Slight variations on this operation occurred over the following 100 years.

Inguinal hernia repair was revolutionized by the recognition that insertion of a sheet of synthetic mesh would provide a tension free repair with recurrence rates less than 1%. The most popular of these is the Lichtenstein repair, which was reported about 1986. This was once the gold standard of mesh hernia repair, but is currently performed less often because other mesh repairs have demonstrated less post-op pain and better recovery.

Our surgeons have been performing laparoscopic mesh hernia repair and "plug and patch" hernia repair for inguinal hernias since 1998 with excellent results, minimal post-op pain and quick return to normal activities. These two options continue to be the procedures of choice for our group.

Hernia surgery using the mesh plug can be performed safely, with minimal postoperative disability, even in patients with multiple medical problems. It is an outpatient procedure, can be performed under local anesthesia, and is minimally invasive. To alleviate symptoms and prevent future complications, we recommend hernia repair in all patients who have a definite hernia and are an acceptable operative risk.

In 1989 the mesh plug hernia repair was instituted by Drs. Rutkow and Robbins at the Hernia Center in New Jersey. By using a "plug" of mesh to fill the hernia defect, followed by an on lay patch of mesh, they found that there was considerably less postoperative pain and more rapid return to normal activities by the patients.

They published a series of 2403 patients in 1994. In that series, the recurrence rate was .005, 3/4 of patients used no narcotic pain pills, and most patients returned to work in 7-10 days. This technique has been used in over 3 million cases nationwide.

We have found similar results in our patients to those of Rutkow and Robbins. For a hernia on only one side, the post-operative pain and disability are nearly equal to laparoscopic hernia repair. However, the mesh plug technique is advantageous because the procedure doesn't require general anesthesia. The Plug, pictured above, looks like a small badminton birdie. The patch is pre-cut to go around the spermatic cord.

We were one of the first groups on the North Shore to perform the plug and patch repair and have used the “perfix plug” pictured below for over a thousand cases. Read more about the PerFix plug.

The plug is inserted into the indirect hernia after the sac is inverted. It is then sewn into place.

The mesh screen is placed over the floor of the inguinal canal and sewn around the spermatic cord. This helps prevent future herniation.

Dr. Haggerty has been using a new mesh plug for the last year call the Ultrapro plug. It involves a similar dissection and repair as the Perfix plug, but is made from a partially absorbable light-weight mesh. The plug is less pointed and the patch portion is larger, which helps prevent future hernias. Read more about Ultrapro Mesh.

We also have extensive experience in performing laparoscopic inguinal hernia repair with mesh. As with other minimally invasive procedures, we use key-hole incisions and a scope into the body.

However, in inguinal hernia repair, we make a space behind the muscle of the abdominal wall down to the pubic bone. This is done by blunt dissection and kept open by infusion of CO2 gas.

We do totally extraperitoneal technique to stay out of the abdomen and prevent complications. The hernia is reduced using blunt graspers and the mesh is rolled up and placed into the space. It is unrolled and placed to widely cover the defect and tacked in place. We have used polypropylene mesh and more recently polyester mesh which may form less scar tissue.

This operation is not as popular nationally as the open repair, but in selected patients it can offer a shorter recovery, less post-op pain, less swelling and possibly less risk of nerve injury. It is also beneficial in younger more athletic males.

Furthermore, it is especially useful in patients who have hernias on both sides and those who have a recurrent hernia. It allows bilateral mesh placement through the same small incisions, significantly reducing the disability. In patients who have had an open mesh repair, the laparoscopic approach from behind the muscle avoids the scar tissue from the prior surgery. This can mean less chance for bleeding or injury to surrounding structures.

We stress an individualized approach to inguinal hernia repair. We believe that using mesh is paramount, but make evidence based decisions on which mesh product and surgical technique is best for the patient. We do not quickly jump from one product to another, but understand that research and development have produced improvements over the last decade. We are experienced in performing both open and laparoscopic hernia repair and will apply whichever one is best suited for each patient.

For an examination to detect whether you have a hernia, or to discuss which hernia repair is best suited for you, call 847-433-1060 to schedule an appointment with one or our surgeons.