Hernia repair refers to a

surgical operation Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

for the correction of a

hernia A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin her ...

—a bulging of

internal organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...

or tissues through the

wall A wall is a structure and a surface that defines an area; carries a load; provides security, shelter, or soundproofing; or, is decorative. There are many kinds of walls, including: * Walls in buildings that form a fundamental part of the super ...

that contains it. It can be of two different types: herniorrhaphy; or hernioplasty. This operation may be performed to correct hernias of the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

groin In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial com ...

, diaphragm,

brain A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in ...

, or at the site of a previous operation. Hernia repair is often performed as an ambulatory procedure.

Techniques

Inguinal hernia repair

The first differentiating factor in hernia repair is whether the surgery is done open, or laparoscopically. Open hernia repair is when an incision is made in the skin directly over the hernia. Laparoscopic hernia repair is when minimally invasive cameras and equipment are used and the hernia is repaired with only small incisions adjacent to the hernia. These techniques are similar to the techniques used in laparoscopic gallbladder surgery. An operation in which the hernia sac is removed without any repair of the

inguinal canal The inguinal canals are the two passages in the anterior abdominal wall of humans and animals which in males convey the spermatic cords and in females the round ligament of the uterus. The inguinal canals are larger and more prominent in males. T ...

is described as a herniotomy. When herniotomy is combined with a reinforced repair of the posterior inguinal canal wall with autogenous (patient's own tissue) or

heterogeneous Homogeneity and heterogeneity are concepts often used in the sciences and statistics relating to the uniformity of a substance or organism. A material or image that is homogeneous is uniform in composition or character (i.e. color, shape, size ...

material such as prolene mesh, it is termed hernioplasty as opposed to herniorrhaphy, in which no autogenous or heterogeneous material is used for reinforcement.

Stoppa procedure

The Stoppa procedure is a tension-free type of hernia repair. It is performed by wrapping the lower part of the

parietal peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothe ...

with

prosthetic In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...

mesh and placing it at a preperitoneal level over Fruchaud's myopectineal

orifice An orifice is any opening, mouth, hole or vent, as in a pipe, a plate, or a body * Body orifice, any opening in the body of a human or animal *Orifice plate, a restriction used to measure flow or to control pressure or flow, sometimes given speci ...

. It was first described in 1975 by Rene Stoppa. This operation is also known as "giant prosthetic reinforcement of the

viscera In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a ...

l sac" (GPRVS). This technique has met particular success in the repair of bilateral hernias, large scrotal hernias, and recurrent or rerecurrent hernias in which conventional repair is difficult and which carries a high

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...

and failure rate. The most recent reported recurrence rate (involving 230 patients with 420 hernias and a maximum of 8 years follow-up) was 0.71%. The totally extra-peritoneal repair (TEP) uses exactly the same principles as the Stoppa repair, except that it is performed laparoscopically.

References

External links

European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.

American Hernia Society

{{Digestive system surgical procedures Hernias Surgical procedures and techniques Digestive system surgery