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A D V E R T I S E M E N T
A D V E R T I S E M E N T
In the past 20 years, it has been recognized that tension on the repaired tissue is the major enemy of permanent hernia repair. This has led to the increasing use of prosthetic mesh in front of the muscular body wall to create a tension-free repair (popularized by Lichtenstein). Tissue grows into the interstices of the mesh, incorporating it into the body to form a strong barrier without the tension often inherent in the natural tissue repairs. This repair is becoming the "gold standard" of hernia repairs done through a standard incision. There is a variation of this repair called the plug-and-patch technique in which a folded wad of mesh material is placed in the hernia defect in addition to the patch overlay.
A D V E R T I S E M E N T
About 1988 there was a dramatic increase in the range of operations done under the guidance of a viewing instrument called a laparoscope. Technical advances in the lens system and the miniaturization of video-cameras led to this leap. Soon after the advent of general surgical applications of laparoscopy, laparoscopic hernia repair was begun.
The early approaches were done by actually entering the abdominal cavity. This has been mostly supplanted by an approach expanding the space between the membrane lining the abdominal cavity and the muscular wall (extraperitoneal approach). Through two additional puncture wounds, long instruments are introduced which dissect, place and fix a piece of mesh in place. There is an ongoing debate about the pros and cons of laparoscopic vs. open repair, and there is no clear answer at this time. Proponents of laparoscopy claim less pain and quicker recovery, but these claims have not yet been proven. The procedure is technically difficult and carries risks not inherent in open repair. At the present time a prudent approach is to use laparoscopy for recurrent and bilateral (both sides) hernia repair primarily, until long term experience accrues.
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A D V E R T I S E M E N T
Interestingly, there is a renewed interest in placing mesh in the position behind the abdominal wall as was done by Stoppa and Nyhus, and as is done by laparoscopy, but now through a minimal incision (Kugel).
At the present time the conservative approach to routine hernia repair is an open repair, usually using the tension-free mesh repair. Those seeking laparoscopic repair should seek out surgeons who are performing the procedure routinely and accumulating significant experience.
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This page was last modified on 2/15/1999.
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