Hernia Repairs

Repairs for hernias have been recently divided into two basic types: tension and non-tension.  National Hernia Network surgeons will make an honest evaluation of your condition and recommend the most appropriate hernia repair. As a general rule, you can trust what your surgeon recommends, but be sure to listen carefully, take notes, and ask questions. The list below includes the most common types of hernia repairs, but it does not include all available procedures so don’t be concerned if the one your surgeon suggests does not appear. The actual success and utility of hernia repairs is an ongoing study and a constant debate. Remember that the most important determinant of the success of your repair is the experience and skill of the surgeon operating. This is much morse important that the actual name of the repair performed.

Common Non-Tension Repairs
Overlay
Prolene Hernia System
Preperitoneal and Intramuscular

The new, less painful, and in general, more successful non-tension repairs usually employ a mesh reinforcement of some sort. The different techniques depend on:
. How the mesh is placed across the defect
. In what layer of muscles
. With what instruments
. What the mesh is made of
. How it is sutured in place

Since the manufacturing of the instruments and mesh is big business, they are often promoted with slick marketing materials. Some surgeons have a procedure named after them or otherwise share in the profits of the use and success of the repair. Therefore, they may not be entirely objective when representing that repair. There are significant differences in the various procedures relating to:
• Recurrence rates
• Complication rates
• Postoperative pain and bruising
• Operating room time
• Total cost
• Recovery time

Common Tension Repairs
Shouldice
Direct Suture (Bassini, McVay)

Tension repairs were the first successful surgical repairs available to the modern surgeon. These repairs take a great deal of skill and time to learn. As with any skill, the benefit of these repairs depends greatly on the knowledge, technique and experience of the operating surgeon. Once the surgeon has mastered these techniques, it is difficult for them to abandon those skills for the newer, less demanding techniques. Therefore, it is more common for older surgeons to still use the tension repairs.  Tension repairs are being performed much less frequently now, but depending on the circumstances, this may be the only repair possible. In those situations, it is recommended that you seek out a surgeon who has experience with many types of repairs, including the tension type repairs.