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Which type of surgery is best to repair a hernia in the groin?

WebMD Medical Reference
Medically Reviewed by Dr Rob Hicks

A hernia in the groin can be repaired by open surgery or keyhole surgery, 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 testiclein men.An inguinal hernia occurs more often in men.You may notice a bulge or lump appear when lifting something but itthen 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?

The hernia can be repaired by a surgeon pushing the lump back into the abdomen and covering it with a patch of mesh 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.

In keyhole surgery, if the surgeon inserts the instruments through the muscle wall in your abdomen, it is referred to as transabdominalpreperitoneal (TAPP), but if the repair doesn't, it is a newer keyhole technique known as totallyextraperitoneal (TEP).

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 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 recommendedfor 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.

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