There are many techniques for hernia repair that are used throughout the US and the world. Most hernia repairs performed today involve the placement of a mesh to result in a tension free repair.
Mesh may be placed as an onlay over the hernia repair or alternatively as an underlay (properitoneal) repair.
Properitoneal repairs may be performed laparoscopically or using open surgical approaches. The original open properitoneal hernia repair described by Stoppa is a tension free repair the does not require sutures. MANY other properitoneal approaches are described. The success of the hernia repair is dictated more on the adequacy of the dissection of the hernia sac rather than the specifics of the type of mesh. I question the ability to adequately dissect a large hernia through a limited open incision. However, small hernias are likely to be amenable to open properitoneal repairs through a small incision
I personally believe that the laparoscopic extraperitoneal approach to groin hernias using a large mesh at least 4 x 6 inches in size offers the best outcomes. The mesh can be placed in the properitoneal space without suture or tacks to avoid postoperative pain associated with fixation. The incisions are small (five or ten mm in size) and the recovery is very rapid. Most patients require pain medications for just a day or two. It does require a general anesthetic. Operative time is around 30 minutes for a unilateral hernia. Bilateral hernias can be repaired without any additional surgical incisions.
Laparoscopy has been shown to be the BEST repair for bilateral hernias and recurrent hernias. However, the treatment of a primary unilateral hernias remains controversial. I believe that the repair best suited for difficult hernias would also be the best for first time hernias.
I have performed many types of hernia repairs over the years, but in general, I recommend the laparoscopic approach for my patients due to the low recurrence rate and rapid recovery.
I would be happy to see you in the Kentucky Hernia Center and examine you to give you a formal opinion.
Sincerely,
J. Scott Roth, MD