Herniotomy
Diagnostics
The most common symptom of a hernia is a swelling in the groin that can extend even into the scrotum. In some cases patients have been reported to suffer from a twinging pain that occured repeatedly during exercise without any palpable swelling. Especially in the case of female patients this could point to a vasculocunar hernia or a developing hernia or a so-called "soft groin".
A hernia is diagnosed during a physical examination of the protusion of the soft part of the groin. Small hernias or developing ones can be diagnosed by ultrasound.
Surgery
Acquired hernias never heal from alone and become bigger in the course of time, which results in an increase of pain. Therefore, a diagnosed hernia is a reason for surgery.
Planned surgery can be performed under general anesthesia, spinal anesthesia or local anesthesia. For the operation on groin hernias several surgical methods have been approved. The method of choice depends the patient's individual medical report and will be discussed during an individual consultation.
Some methods work with abdominal incision, others with laperoscopy, some work with plastic nets, some don't.
Methods
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Shouldice Operation
This method is marked by a strengthening of the posterior groin channel by four sutures without the insertion of a plastic net. This method is mainly used on younger patients and can be performed under local anesthesia. -
Lichtenstein Operation
This surgical method requires the inlay of an exogenic material in the shape of a plastic net to strengthen the posterior wall. A thin net gets sewed to the posterior wall of the groin channel to strengthen the tissue. This surgical method is preferred for large hernias and older patients, as well as for patients suffering from blood-clotting disorder. -
Endoscopic Surgery (Minimal Invasive Surgery)
This endoscopic surgical method always requires the inlay of a plastic net between peritoneum and abdominal wall, and can only be performed under general anesthesia. Our clinic prefers this method because it has proven to be very effective in cases of bilateral groin hernias and reappearing hernias (recurrent hernia).
Surgical Risks
To leave a hernia untreated means to increase the risk of a strangulation which would require emergency operation. The risk of strangulation is higher with small hernias, but all in all the risk of a lasting strangulation is small.
There is a small risk that vessels or spermatic cords can be damaged during surgery.
The rate of wound infections is about 2 % for common incision surgery and can be neglected for endoscopic methods.
A chronic pain in the groin can occur after general surgical methods in 1-2 % of the patients.
Recurrence Rate
Shouldice operation shows a recurrence rate of 0,5-8 %. Lichtenstein operation can reduce this rate thanks to the use of a plastic net.
Endoscopic methods show the lowest recurrence rate, 1-2%.
Special Questions
- Under certain circumstances Shouldice operation can be performed ambulatory while Lichtenstein operation and endoscopic methods require a stay in hospital for 3-5 days.
- The aim of the operation is an early rehab of the patient's exercise tolerance depending on the surgical method.
The carrying of heavy loads (more than 5kg) should be avoided for:
- 4 weeks after Shouldice operation
- 3 weeks after Lichtenstein operation
- 1-2 weeks after endoscopic surgery
- Endoscopic methods always require the insertion of a drain, general methods only when needed. Wound closure is done by invisible dermal stitches which don't afford a removal of sutures.
