Inguinal hernia surgery: types, advantages and complications

• An inguinal hernia develops due to a weakening of the abdominal wall in the groin area whereby the bowel or other organ in the area can protrude, showing as a bulge in the area.
• Inguinal hernia surgery can be performed mainly by two techniques: open or conventional surgery and minimally invasive laparoscopic surgery.
• After inguinal hernia surgery, whichever technique is used, the pain is eliminated and the patient's quality of life is restored in just 3 weeks of recovery.

Inguinal hernia surgery is performed with the main objective of eliminating symptoms such as pain in the abdominal and inguinal area and the various discomforts caused by the displacement of one or more organs through the hole that has occurred in the abdominal wall.

On the other hand, an inguinal hernia may not cause pain or other problems, so in principle you can go on with your day-to-day life without requiring surgery. 

However, these hernias do not go away on their own or manage to repair themselves, but become larger and can lead to major problems such as incarceration, inguinal hernia strangulation or bowel occlusion. 

These complications can be life-threatening and, of course, require emergency surgery.

There are different types of inguinal hernia surgery, with the main difference being improvements in recovery.

The definitive treatment of inguinal hernia is always surgical, but it can be performed by different types of repair surgery, all of which have the same objective: to reintroduce the bulging tissue by strengthening the abdominal wall with or without mesh and by making the stitches that will act as a support.

As is the case with many surgical treatments, nowadays, one can resort to different types of techniques to solve the same problem. In this case, that of inguinal hernia surgery, we can differentiate between treatments with mesh, either by laparoscopic surgery or open surgery, or, on the other hand, there is the treatment of repair without mesh using various suturing techniques, however, the latter are practically in total disuse in most countries.

Below we explain them one by one so that you can learn about the differences between each type of inguinal hernia surgery and what each of these types consists of:

Open inguinal hernia repair with mesh

Open inguinal hernia surgery is known as the conventional operation to repair the wall of the abdomen through which an organ has protruded. This repair basically consists of placing a sterile mesh in the upper part of the defect, reinforcing the inguinal region and stitching to secure the fastening, as well as closing the incision to access the area.

This is a tension-free type of surgery, i.e. the stitches do not exert tension on the abdominal muscles, which means that post-operative recovery is usually significantly reduced. In addition, this inguinal hernia surgery is performed under general or spinal anaesthesia and lasts approximately 30 to 40 minutes.

Nowadays, two types of mesh surgery are used to repair an inguinal hernia: open inguinal hernia repair and laparoscopic inguinal hernia surgery.

Laparoscopic mesh repair

Laparoscopic inguinal hernia surgery is a minimally invasive repair operation. During this type of inguinal hernia surgery, mesh is placed in the area of the defect through small incisions in the abdomen.

To carry out this surgery, the aforementioned incisions are made, through which the surgical instruments and the tiny camera are introduced to observe the interior, thus avoiding making a large incision and reducing the post-operative recovery period to a minimum. 

This is generally performed under regional or general anaesthesia, in order to guarantee a correct execution of all the steps and to ensure that the patient cannot feel anything during the surgery.

It is a surgery that, although it has advantages in terms of recovery, shorter than the other types of approach, it does involve a longer intervention time, which can be between 90 and 120 minutes.

Non-mesh suture repairs

Suture inguinal hernia repairs are a type of open surgery in which no mesh is used to repair the defect or opening in the abdominal wall through which the bowel or other organ in the area protrudes.

These are operations to reconstruct the four layers of fascia (a very strong connective tissue structure that envelops all body structures. Giving support, protection and shape to the body) or suturing to reattach the involved areas where the inguinal hernia has occurred.

This type of inguinal hernia repair can be performed in several different ways:

• Inguinal hernia repairs with tension sutures: either with the Bassini technique, in which the joint tendon (formed by the distal ends of the transversus abdominis and the internal oblique muscles) is sutured to the inguinal ligament, or the Shouldice technique, in which the various layers of the abdominal wall are reconstructed until the defect is repaired.
• Inguinal hernia repairs with tension-free sutures: this type of repair can be performed using the Desarda technique, in which resorbable sutures are used; it is a technique free of tension on the muscles, free of mesh and which takes into account the physiological characteristics of each patient. There is also the Guarnieri technique, another tension-free suture repair technique that can be performed with or without mesh. Like the previous technique, it pays attention to physiology.

However, as we mentioned at the beginning of this article, this type of groyne surgery with sutures and without mesh is no longer usually performed, as repair interventions with mesh placement give better results and minimise the likelihood of the pathology recurring.

Although you can already imagine what the main advantages of inguinal hernia surgery are, clearly, correcting the defect and eliminating the daily discomfort and pain caused by it, thus improving your quality of life, we will now focus on the advantages of each of the types of inguinal hernia surgery that exist.

But first, we will tell you that by correcting the inguinal hernia, we eliminate the possibility of hernia complications such as those mentioned above, incarceration or strangulation of the hernia. However, each type of inguinal hernia surgery has its own advantages:

Advantages of open inguinal hernia surgery

Regarding the advantages of open inguinal hernia surgery, specialists highlight:

• Suitable for patients with high operative risk: the open or conventional technique can be performed under local anaesthesia with sedation, regional anaesthesia or general anaesthesia, which makes it suitable for patients who have additional problems or conditions in addition to the hernia and for whom some type of anaesthesia is contraindicated.
• Short intraoperative time: the duration of open inguinal hernia surgery is only 30-40 minutes.
• Hospital stay: the time you will have to stay in hospital after surgery is very short, usually after one night you can go home.
• High success rate: after open inguinal hernia surgery the chances of recurrence are minimal, being 1 to 10 out of every 100 surgeries performed.

One of the main advantages of inguinal hernia surgery with mesh is that the hernia defect is not closed, but covered by the prosthetic material, which significantly reduces hernia recurrence.

We know that undergoing surgery is always a complicated decision and, in addition to the advantages of the treatment, you always consider the possible risks and complications that you may face in the event that something goes wrong. 

Don't worry, we can assure you that the risks and complications of inguinal hernia surgery are very rare, and if they do occur, they are all controlled and resolved quickly by the expert hands of the surgeon and his team.

Serious complications occur less frequently, with very low percentages (0.13% - 0.65%) among all patients who have undergone surgery who may have had vascular damage or damage to adjacent organs in the abdomen.

However, here's a breakdown of the risks you may face during inguinal hernia surgery:

• An adverse reaction to the anaesthesia: as in any type of surgery, there are possible risks related to the reaction that the anaesthesia may cause in the patient.
• Infection and bleeding from the incision: if these occur, they are completely controllable and are treated with drugs to reduce their duration and prevent them from becoming more complicated.
• Nerve damage, numbness of the skin, loss of blood supply to the scrotum or testicles resulting in testicular atrophy (in the case of men). All of these are very unlikely to occur, especially if you are in expert hands.
• Damage to the tube that carries sperm from the testicles to the penis (vas deferens). This complication, like the previous ones, is very unlikely to occur and even less likely to occur in surgeries performed by experienced specialists.
• Damage to the femoral artery or vein: during insertion or removal of instruments during surgery. This is a very rare complication and can be treated during surgery without aggravating the problem.

If you are thinking of solving the problems caused by the development of an inguinal hernia, you can request a surgical assessment consultation by contacting our patient service team, clicking on make an appointment or by calling at +34 91 141 33 56.

• Unidad de Cirugía Mayor Ambulatoria y Corta Estancia. Hospital Regional Universitario de Málaga. (2018, mayo). Hernioplastia inguinal abierta: técnica de Lichtenstein. Asacpharma. https://www.asacirujanos.com/admin/upfiles/revista/2018/Cir_Andal_vol29_n2_multimedia3.pdf
• Simons, M. P., Smietanski, M., Bonjer, H. J., Bittner, R., Miserez, M., Aufenacker, T. J., Fitzgibbons, R. J., Chowbey, P. K., Tran, H. M., Sani, R., Berrevoet, F., Bingener, J., Bisgaard, T., Bury, K., Campanelli, G., Chen, D. C., Conze, J., Cuccurullo, D., de Beaux, A. C., Wijsmuller, A. R. (2018). GUÍA INTERNACIONAL PARA EL MANEJO DE LA HERNIA INGUINAL. European Hernia Society, 22(1), 3–23. www.europeanherniasociety.eu/files/medias/cov13178_ehs_groin_hernia_management_a5_es_10_lr_0.pdf