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Consent for a inguinal hernia repair

Author:Lengyel J.
on 29 Aug, 2007

Last edited by: Lengyel J. on 12 Oct, 2007
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Consent for hernia repair
 
Benefits
Close the defect,
Alleviate symptoms of discomfort,
Prevent serious complications (obstruction or strangulation of the bowel) reduce the risk of recurrence.
 
Technique then should enter the discussion
NICE guidance on this says that open/ TAPP / TEPP are the 3 main ways to repair a hernia
10% all hernias are repaired laparoscopically
90% open.
 
Pros/ cons of each
 
Open
  • Tried and tested over 15 years of surgical practice and is the commonest way hernias are repaired
  • Technique:
    • groin incision
    • reduction of the hernia and excision of the sac
    • placement of mesh ( low risk of recurrence <1%)
  • Risks
    • Bleeding
    • Wound infection
    • Urinary retention
    • Chronic pain / numbness– 10%
 
Laparoscopic
  • New techniques. Advantages are:
    • Less post operative discomfort
    • Earlier return to normal activities (3 days in 7 RCT’s)
    • Lower incidence of chronic pain / numbness ( 2%)
    • Recurrence 2% vs 1% open repair
    • Fewer wound complications. When complications did occur they were generally more severe with laparoscopic approach ( vascular injury or bowel injury)
    • Having said that rates of complications should be low if done by a surgeon appropriately trained in laparoscopic hernia repair.
 
 
Overall summary from NICE.
           
            Laparoscopic repair of inguinal hernia was likely to result in considerably less postoperative pain and numbness than open repair.
There was uncertainty over the rates of recurrence and of serious complications associated with laparoscopic surgery for primary repairs.
The preferred technique for the repair of recurrent and bilateral hernias should be laparoscopic. Consideration should be made for primary repair of unilateral hernias because of the reduced incidence of long-term pain and numbness and the potential for earlier return to normal activities. The rates
 
 
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