Surgery for Hernia

Open repair of a hernia is typically performed when someone has a single hernia and has never had one before. In this procedure, the surgeon makes an incision in the groin or abdomen, returns the muscle, organ, or other tissue to its original position, and removes the sac that held the hernia. The surgeon may either sew together healthy muscle or insert a mesh to reinforce the weakened area.

There are several types of open repairs. All take about one hour to perform and require general anesthesia.

Lichtenstein Repair

At NYU Langone, Lichtenstein repair surgery is usually used to correct inguinal hernias. It is a “tension-free” repair, meaning a mesh material is used to reinforce the weakened area instead of using sutures, which can create tension in that area of the body, similar to that which caused the hernia.

In this procedure, a doctor makes an incision in the groin, returns the tissue or organ to its original location in the abdomen, and then closes off and removes the sac.

Next, he or she places a mesh material over the weakened area of the inguinal canal. In time, new tissue attaches to the mesh to reinforce the abdominal wall, relieving tension and reducing the risk of a recurrent hernia.

Shouldice Repair

In a Shouldice hernia repair, the surgeon returns the tissue and organs inside an inguinal hernia to their original position. Next, he or she creates flaps with four layers of tissue, or fascia. He or she then overlaps the layers and uses steel sutures to strengthen the weakened area of the inguinal canal.

Bassini Repair

In a Bassini hernia surgery, the surgeon pulls together and sutures, or sews, muscles to cover the hole in the inguinal canal. This repairs the hernia. Bassini repair is typically used if mesh repair isn’t possible, such as when a part of the intestine has been removed due to a strangulated hernia.

Plug and Patch Repair

In a plug and patch hernia procedure, the surgeon reaches the hernia through an incision in the groin or abdomen and places a mesh plug into the hole to the hernia. It’s then secured with a patch that’s sutured in place.

Your doctor may perform laparoscopic surgery for an inguinal hernia, particularly if you have bilateral hernias—one on each side—or if a previous open repair didn’t correct the hernia or prevent it from returning.

In laparoscopy, the surgeon makes an incision in the peritoneum, a layer of tissue that lines the groin, and uses surgical tools to fix the hernia. Because laparoscopic surgery requires smaller incisions, it usually results in smaller scars and less pain after surgery.

Laparoscopic repair is typically performed with general anesthesia.

Totally Extraperitoneal Repair

In a totally extraperitoneal hernia repair, three small incisions are made: one below the belly button, one above the pubic bone, and one in between. Through the incisions, the surgeon inserts an instrument that has a camera, surgical tools, and a small balloon at the tip. He or she moves these to the extraperitoneal space, which is outside the abdominal cavity.

The surgeon inflates the balloon to push away tissue, fat, and organs, making the area more visible. Tissue and fat are removed from the hernia’s sac, and the weakened area is reinforced with a mesh material, which is attached with stitches or tiny tacks. The surgeon then withdraws the surgical tools and closes the incisions with sutures.

Transabdominal Preperitoneal

Transabdominal preperitoneal laparoscopy is the same surgery as totally extraperitoneal repair, except one incision is made through the groin. Through this incision, the surgeon inserts the instruments into the abdomen.

In robotic-assisted hernia repair, a specially trained surgeon controls laparoscopic surgical instruments that are mounted on robotic arms. A separate arm contains a camera that creates high-definition, three-dimensional images on a computer monitor, which guide the surgeon during the surgery.