Which type of surgery is best to repair a hernia in the groin?
Open surgery or keyhole surgery are both options to repair a hernia in the groin - but is one type of surgery better than the other?
What is an inguinal hernia and does it need repairing?
A hernia in the groin is also known as an inguinal hernia. It can occur if there is a weak spot in the muscles in your abdomen that allows part of the bowel or fatty tissue to squeeze through into the groin, or into a testicle in men. An inguinal hernia occurs more often in men. You may notice a bulge or lump appear when lifting something but it then disappears when you lie down.
If the hernia causes persistent or severe problems or there is a risk of a serious complication – such as an obstruction (where part of the bowel becomes stuck) or strangulation (where part of the bowel is trapped and no longer has a blood supply) – your doctor may recommend surgery. A strangulated hernia requires an emergency procedure.
How is the hernia repaired?
Hernia repair can be done by pushing the lump back into the abdomen then covering it with a mesh patch to hold it in place. There are two types of surgery for doing this:
- Open surgery, where the surgeon makes one cut into the groin in a procedure known as the Lichtenstein repair.
- Keyhole (or laparoscopic) surgery, where the surgeon makes several small cuts in and around your belly button to insert a camera to see the groin and surgical instruments to make the repair.
Which method of surgery is best?
The National Institute for Health and Care Excellence (NICE) has approved both procedures as being safe and working well, but there are pros and cons to each:
- Keyhole surgery is less painful afterwards because the cuts are smaller and there is less muscle damage.
- Open surgery has fewer risks of complications – in keyhole surgery there is a greater risk the surgeon can accidentally damage the bowel.
- Keyhole surgery has a faster recovery time in recurrent cases, where a hernia returns, or if it is a bilateral repair, with a hernia on either side.
The type of surgery chosen may also be based on the patient's circumstances:
- Open surgery is recommended for people who should not be given a general anaesthetic, such as the elderly and people in poor health.
- Keyhole surgery is recommended for women, who have a higher chance of another undiagnosed hernia.
- Keyhole surgery is recommended for very active patients with pain as the most dominant symptom.
Keyhole surgery may also be recommended if your surgeon is not sure about the type of hernia you have.
One study in the Netherlands, published in 2012, compared inguinal hernia operations performed on 660 people using either open surgery or keyhole surgery. The researchers looked at how likely it was that people would feel pain in their groin after 5 years and what impact the surgery had on their health and daily lives. They found:
- In people who had keyhole surgery, 15% still had pain after 5 years, but in open surgery the numbers increased to 28%.
- Numbness from nerve damage in the groin area occurred in only 1% of people who had keyhole surgery, but in 22% who had open surgery.
- Hernias came back in about 5% of people who had keyhole surgery but in 8% in those who had open surgery.
- Complications occurred in 6% of people who had keyhole surgery, compared to 2% in those who had open surgery; nerve damage was the most common problem.
The authors of the study also found patient satisfaction to be much higher in those who had keyhole surgery.
Not all surgeons have enough experience to perform keyhole surgery, so your surgeon's experience may be the determining factor in the choice of surgery as well as other criteria such as whether the patient can be given a general anaesthetic.