A surgical intervention is by far the best method to treat a hernia. It provides long lasting relief and mobility to the patient. Hernia repair is a very common surgery with routine procedures.
The open surgery treatment option is one of the proven repair techniques where the surgeon identifies the hernia through an incision. It is then placed back in its place after reinforcement of weak tissue with a synthetic mesh. The mesh prevents the hernia to push itself into the weak spot again.
Open Inguinal Hernia Repair
There are three types of open inguinal hernia repair:
- Herniotomy ??? Only the hernial sac is removed. First, the three superficial veins are ligated and divided. Then the external oblique aponeurosis is divided and reflected. The iliolingual nerve is identified and reflected over the aponeurosis. The creamasteric muscle and the internal spermatic fascia are divided. The hernial sac is then identified and dissected up to its neck.
- ??Hernioplasty ??? This procedure is done in combination with the herniotomy reinforcing and repairing the posterior inguinal canal with either heterogenous or autogenous material.
- ??Bassini???s herniorraphy ??? Also done in combination with the herniotomy, this surgery attempts at strengthening the posterior wall of the inguinal canal. Indications for such a surgery are indirect or direct hernia with a good muscle tone. The hernial sac is identified and the contents examined. The contents are then reduced and the sac twisted to avoid any injuries.
Open Ventral Hernia Repair
Anaesthesia and elective repair are chosen depending on the size of the hernia. An incision is made according to the size of the defect. The hernial sac is identified and opened. The contents of the sac are reduced and pushed back into the abdominal cavity. Under direct vision, the intraabdominal adhesions are lysed. The patch size is determined and prosthetic mesh is placed into the area.
Open Femoral Hernia Repair
There are basically three approaches for the open femoral hernia repair:
- The infra-inguinal approach ??? An elective repair, the approach is from below the femoral canal. An oblique 1 cm incision is made parallel and just below the inguinal canal.
- ??Trans-inguinal approach ??? An incision above the inguinal canal of about 2 cm is made. This dissects through the inguinal canal. Basically the area is explored for the presence of a femoral hernia and repaired.
- The high approach ??? The skin incision made in this type of approach is oblique and 3 cm over the pubic tubercle. The lateral border of the rectus muscle is divided to allow preperitoneal dissection of the hernial sac.
Open Umbilical Hernia Repair
The umbilical hernia repair is done with Mayo Repair technique. An incision is made in the aponeurosis and longitudinally extended on both sides of the hernial defect. Excision of the sac is accomplished and the sac is transected from the umbilicus. The contents of the sac are examined and reduced. All scar tissues and adhesions are lysed.
Open Epigastric Hernia Repair
After administration of local anaesthesia an incision is made in the palpable mass that extends into the subcutaneous fat. Once the level of the hernia is reached, it is freed with gentle dissection or pushed back into position. A sterile under-lay mesh is then placed to reduce the pressure.
Open Hiatal Hernia Repair
General anaesthesia is administered and a midline incision is made up to the navel starting from the breast bone and through the tissues of the abdominal cavity. The liver is then lifted up for better access to the esophagus and the diaphragm. The esophagus is pulled upward and the hiatus is closed with sutures.