What is Inguinal Herniorrhaphy?

• There are two types of surgical techniques to solve an inguinal hernia, herniorrhaphy and hernioplasty.
• Nowadays, the most commonly used surgical technique is hernioplasty as opposed to herniorrhaphy, as it has a lower recurrence rate.
• To perform an inguinal herniorrhaphy, the herniated part is first reintroduced into the abdominal cavity and then the defect in the abdominal wall is sutured.

Inguinal hernia occurs mainly due to overexertion such as heavy lifting, recurrent coughing, constipation or any other problem involving overexertion in the area.

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It is not always necessary to operate on inguinal hernias, but the only way to solve it definitely is surgery, for which there are techniques such as herniorrhaphy and hernioplasty.

Inguinal hernia consists of a defect in the pelvic-abdominal cavity that causes the peritoneum to protrude outwards, forming a bulge known as a hernial sac. As the name suggests, they are located in the groin area and appear mainly in adult men.

In some cases, part of the intestine is introduced into the hernia sac, causing serious problems because the intestine can become strangulated, reduce the blood supply and initiate a process of necrosis that will require emergency surgery.

Of the two surgical techniques that can be used, herniorrhaphy is the less commonly used today because it involves suturing the layers of the abdomen and causes muscle tension in the area, whereas surgical mesh hernioplasty is the more commonly used. 

You will also find information about inguinal herniorrhaphy below.

Inguinal herniorrhaphy consists of opening the affected area, reintroducing the hernia sac and suturing the abdomen layer by layer to repair the defect in the abdominal cavity.

There are several techniques to carry it out, the choice of which will always depend on the surgeon who performs the operation, although, as we mentioned, inguinal hernia repair with surgical mesh is most likely to be performed:

Inguinal herniorrhaphy according to Bassini

This is the first inguinal hernia repair technique described. Inguinal hernia repair according to Bassini dates back to 1880 and was based on the suturing in tension of all the edges that made up the abdominal wall defect.

In this case, we can affirm that this technique is obsolete, at least in countries with an advanced health system, as in these cases they opt for hernioplasty with surgical mesh or other herniorrhaphy techniques such as the Shouldice herniorrhaphy.

Inguinal herniorrhaphy according to Shouldice

Inguinal herniorrhaphy is a complicated technique that requires a surgeon who is very experienced in this type of inguinal herniorrhaphy. Despite this, this technique in the hands of a skilled surgeon has a very low recurrence rate.

Today, like all other types of inguinal herniorrhaphy, it is falling into disuse as the Lichtenstein repair with surgical mesh is simpler and the immediate postoperative pain is greater than in hernioplasties.

Shouldice inguinal herniorrhaphy consists of a reconstruction of the four layers that form the deep abdominal fascia.

Desarda inguinal herniorrhaphy

This is a relatively new technique that involves the use of absorbable sutures to perform the herniorrhaphy. It is a tension-free technique and does not require mesh as the repair is performed according to the patient's own physiology.

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Guarnieri inguinal herniorrhaphy

In this case, the technique was first used in 1988 and is performed with or without mesh. In the same way, the patient's physiology is taken into account and it is tension-free, reducing postoperative discomfort.

The choice must always be agreed between the surgeon and the patient, having established the pros and cons of choosing between herniorrhaphy or hernioplasty. 

In general, the most recommended procedure nowadays is hernioplasty with surgical mesh, which allows a simpler intervention and a more comfortable postoperative recovery, thus alleviating the problem and the discomfort of inguinal hernia in a satisfactory manner.

In the case of inguinal hernioplasty with surgical mesh, these can be performed by open surgery, which consists of an incision up to the herniated area, reintroduction of the hernia sac into the abdominal cavity and placement of a surgical mesh to solve the defect in the wall and then sewing the incision area layer by layer; or by laparoscopic surgery, which allows repair from inside the abdominal cavity using a laparoscope and placing the surgical mesh from the inside, improving recovery times and postoperative pain with respect to surgical treatment and especially with respect to inguinal herniorrhaphy.

• Hernias inguinales y crurales (hernias de la ingle). (2009). Dr. Jorge Abraham Arap. http://scielo.sld.cu/pdf/cir/v48n2/cir10209.pdf
• Hernia inguino crural. Guía de Práctica Clínica. (2007, abril). Consellería de Sanidade, Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, avalia-t; 2007. Serie Avaliación de Tecnologías. Guías de Práctica Clínica: GPC2007/01. https://www.sergas.es/Docs/Avalia-t/GPC2007_01completa.pdf