Recent studies show that laparoscopy operation to repair a hernia can reduce the pain and other symptoms of a hernia without the need for invasive surgery.
What we already know
If you have a hernia in your groin (called an inguinal hernia), doctors will often recommend an operation to repair it. An inguinal hernia is a bulge you can see or feel in your groin, caused by a weak spot in the muscles in your abdomen. To repair the hernia, a surgeon will usually push the lump back inside your body and cover it with a patch of mesh to keep it there.
There are two different ways surgeons usually repair inguinal hernias. During open surgery, a surgeon makes a cut directly into your groin. In laparoscopic surgery, a surgeon makes a small cut in or around your belly button and then uses a laparoscope to see inside your groin. Both types of operation will fix the lump in your groin but they have different risks and benefits.
New Studies
The Comparison between Open and Laparoscopic Inguinal Hernia Surgery
To explore how these operations compare, researchers randomly assigned 660 people with an inguinal hernia to have either a type of open surgery or a type of laparoscopic surgery.
After five years, they compared how likely people in each group were to have pain in their groin, and how much impact the operation had on their health and daily lives.
People who had laparoscopic surgery were less likely to still have ongoing pain in their groin five years after surgery. Around 15 people in every 100 who had laparoscopic surgery still had pain after five years, compared with 28 people in every 100 who had open surgery.
Numbness in the groin is a common problem after hernia surgery if the nerves in the groin are damaged. In people who had laparoscopic surgery, only 1 in 100 had this problem after five years, but around 22 people in every 100 who had open surgery reported numbness.
After five years, hernias had come back for around 5 in every 100 people who had laparoscopic surgery, and in around 8 in every 100 people who had open surgery.
People who had laparoscopic surgery were also more likely to say they were satisfied with their operation and were more likely to have resumed their normal daily activities and returned to work. But more problems (complications) occurred during laparoscopic surgery than open surgery. Following laparoscopic surgery, 6 people in every 100 had complications, compared with 2 people in every 100 who had open surgery. The most common problem was nerve damage during the operation.
Results
These findings should be reliable, as this was a randomised controlled trial, which is the best type of study for finding out the effects of a treatment.
The results of this study suggest laparoscopic surgery to repair an inguinal hernia is a good option for most people. It’s a treatment that we know is likely to work. You are less likely to continue to have pain in your groin if you have this type of operation than if you have open surgery, and your hernia is no more likely to come back.
This study did find that three times as many people have complications with laparoscopic surgery as with open surgery. But in the long term, people who had complications during the operation weren’t any less likely to recover than those who didn’t.
If you need an operation to repair an inguinal hernia, it’s worth discussing with your surgeon if laparoscopic surgery is the right option for you.
Laparoscopic Repair of Inguinal Hernia with Biomimetic Matrix
The repair of an inguinal hernia is the most commonly performed abdominal general surgery procedure. Over time, many aspects of the surgical technique to repair inguinal hernias have evolved, namely the approach and type of mesh material used to reinforce the repair. In recent years, laparoscopic surgery has emerged as a viable approach, further advancing the treatment of inguinal hernia. Today, the types of mesh material available to surgeons are numerous which fall into 2 broad categories: synthetics (like polypropylene or polyester) and biologics (derived from human and animal tissue).
While the type of mesh material has evolved, there is no gold standard. Each category has its merits and drawbacks. The synthetics have a permanent, inherent strength but are associated with some incidence of chronic pain. It is believed that this chronic pain results from the formation of scar plate and unorganized tissue healing response. Physicians looking for a more natural healing solution that is not a permanent implant have moved toward the use of biologics. The biologics rely on variable tissue regeneration to give strength to the repair, limiting their use to specific situations. However, due to tissue ingrowth, the biologics do not result in a significant incidence of chronic pain.
Biomimetic Matrix
This study evaluates Biomimetic in an attempt to obviate the disadvantages of each material. Biomimetic surgical mesh consists of a novel biomaterial that combines the favorable properties of a biologic to support robust tissue ingrowth with the durability of a synthetic. The permanent structure of the mesh creates a strong mechanical repair, while its unique microarchitecture supports tissue ingrowth and formation.
Biomimetic is shown in histology and in vivo to demonstrate regeneration and tissue ingrowth similar to that in the biologics rather than scarring. There were no recurrences, indicating its strength and resilience as a permanent repair similar to that in the synthetics.
This is proof of the concept that a biomimetic may bridge the gap between the biologics and synthetics and may be able to be utilized on a regular basis with the benefits of both materials and without their drawbacks.
References:
Eker HH, Langeveld HR, Klitsie PJ, et al., “Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs lichtenstein repair”, Archives of Surgery, vol. 147, no. 3, pp. 256-260, 2012.
Fine A, “Laparoscopic repair of Inguinal Hernia with Biomimetic Matrix”, Journal of the Society of Laparoendoscopic Surgeons, vol. 16, no. 4, pp. 564-568, 2012.
