Herniorrhaphy

A herniorrhaphy generally refers to the operation for repair of an indirect or direct inguinal hernia, although it should apply to any hernia repair. It can be performed by an open or laparoscopic technique.

This operation is usually performed under general anaesthetic, although, in patients with poor cardiovascular or respiratory function, epidural or spinal anaesthesia may be used. Some surgeons repair most inguinal hernias under local anaesthetic.

It is worth observing three salient points:

• normal anatomy should be restored as far as possible
• fibrous union is only possible if tissues of similar tensile qualities are sutured, i.e. tendon to aponeurosis and not muscle to fascia
• the suture must retain its strength: only non- or slowly absorbable types are advised

NICE guidance states that for the repair of primary inguinal hernia, open (mesh) should be considered the preferred surgical procedure. However for the repair of recurrent and bilateral inguinal hernia, laparoscopic surgery should be considered (1).

Reference:

• 1) NICE (April 2001). Summary of Guidance issued to the NSH in England and Wales, Laparoscopic surgery for inguinal hernia, 2, 22.