In our last blog post discussing the International Guidelines for Groin Hernia Management, we reviewed how hernias are diagnosed and when patients should have surgery. Today I’d like to discuss what can help patients (and their surgeons) make the decision on what type of surgery to have for their hernia.
The determinants for an optimal surgery would be one with very few complications (primarily recurrence rates and chronic pain), easy recovery, the ability to reproduce the surgical results over and over, as well as cost effectiveness. The first determination in most surgeons minds would be whether to use mesh, or not to use mesh. As we’ve tried to discuss at length on our website, we feel that mesh is a critical component of reducing complications after surgery, and in particular, recurrence rates. The data reviewed in this International Guidelines took into account dozens of studies and thousands of patients. The data suggested that for some large hernias, the recurrence rates for a non-mesh surgery are as high as 13%, while the recurrence rates for hernias repaired with mesh is closer to 2-3%.
Some data showed that the Shouldice method performed in Toronto Canada can have recurrence rates closer to the 2-3% found in the mesh repairs but other studies have shown the Shouldice method to have recurrence rates of 4-7%. Even if it’s recurrence rates were 2-3%, since this technique can be very complicated to learn, few surgeons know the procedure, and it doesn’t have a lower risk of other complications (like chronic pain), it isn’t recommended as a substitute for a mesh repair. In summary, these international guidelines which take into account thousands of patients and medical studies along with leading experts in hernia surgery from around the world recommend that patients undergo a mesh repair for their hernia.
The next decision point is whether to have open hernia repair or laparoscopic hernia repair. The International Guidelines again looked at 1000’s of patients, and dozens of medical research studies and concluded that no one surgery is recommended for all patients. The results from open and laparoscopic surgery are very similar in the long term when comparing complications. There is a slight trend towards easier recovery in the laparoscopic group within the first days after surgery and patients pain levels. But over time for standard hernias, both open and laparoscopic have similar results in terms of recurrence, post operative complication, and long term chronic pain. However, for some patients, one technique may be more indicated over the other due to patient factors.
Thus, an important part of making the correct decision on the type of hernia surgery, is finding a surgeon who can offer both laparoscopic and open techniques. This ensures that patients are able to undergo the procedure that best fits their particular needs. As expected, the data also suggests that finding a surgeon with a high volume of hernia repairs is important when choosing a surgeon to operate on your hernia.