Choosing the Right Hernia Surgery: Traditional vs. Laparoscopic Options - Urology

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Regarding hernia issues?


I have a confirmed hernia issue, diagnosed by a doctor, and I have undergone imaging tests for confirmation.
I am currently planning for surgery but am still uncertain about the surgical approach.
The surgical options I know of that involve the use of a mesh are: 1.
Traditional open surgery at the hernia site (approximately 5-7 cm incision) and 2.
Totally Extraperitoneal Hernia Repair (TEP) using laparoscopic techniques.
I am unsure which option to choose.
I have consulted with various physicians, but their opinions have varied.
I understand that the second option results in a smaller incision and faster recovery, but my hernia has been present for quite some time and is quite large.
I have heard that if a hernia is too large, the recurrence rate may be higher with the second option and that it may be more challenging to treat.
Is this true?

Shanqi went tiwen, 30~39 year old female. Ask Date: 2017/07/21

Dr. Xu Wencang reply Urology


It shouldn't be too different.
Laparoscopic totally extraperitoneal repair requires general anesthesia, and if the hernia is incarcerated, laparoscopic surgery may not be possible.
It's best to discuss the optimal approach with your physician.

Reply Date: 2017/07/21

More Info


When it comes to choosing the right surgical approach for hernia repair, particularly between traditional open surgery and laparoscopic (or minimally invasive) surgery, there are several factors to consider. Both methods have their advantages and disadvantages, and the choice often depends on the specific circumstances of the patient, including the size and type of hernia, the patient's overall health, and the surgeon's expertise.


Traditional Open Surgery
Traditional open hernia repair involves making a larger incision (typically 5-7 cm) at the site of the hernia. This method has been used for many years and is well-established. The advantages of open surgery include:
1. Direct Access: Surgeons have direct access to the hernia, which can be beneficial for larger or more complicated hernias.

2. Familiarity: Many surgeons are more experienced with open techniques, especially for complex cases.

3. Lower Recurrence Rates for Large Hernias: Some studies suggest that for larger hernias, open repair may have lower recurrence rates compared to laparoscopic repair.

However, the disadvantages include a longer recovery time, more postoperative pain, and a larger scar.


Laparoscopic Surgery
Laparoscopic hernia repair, on the other hand, is performed through several small incisions using a camera and specialized instruments. The benefits of this approach include:
1. Smaller Incisions: This results in less postoperative pain and a quicker recovery time.

2. Less Scarring: The cosmetic outcome is generally better due to smaller scars.

3. Faster Return to Normal Activities: Patients often return to their daily routines more quickly compared to open surgery.

However, there are some concerns, particularly for larger hernias:
1. Higher Recurrence Rates for Large Hernias: Some studies indicate that laparoscopic repair may have higher recurrence rates for larger hernias, especially if the hernia has been present for a long time.

2. Technical Challenges: Laparoscopic surgery can be technically more challenging, and not all surgeons may have the same level of expertise with this technique.


Considerations for Your Situation
Given that your hernia has been present for a significant amount of time and is of considerable size, it is crucial to discuss these factors with your surgeon. Here are some points to consider:
- Surgeon's Experience: Ensure that your surgeon has substantial experience with both techniques, particularly with laparoscopic repair for larger hernias.

- Hernia Characteristics: The specific type and size of your hernia may influence the decision. If it is a large hernia, your surgeon may recommend open repair to minimize the risk of recurrence.

- Recovery Time: If a quicker recovery is a priority for you, laparoscopic surgery may be more appealing, but weigh this against the potential for higher recurrence.

- Second Opinions: If you are uncertain, seeking a second opinion from another qualified surgeon can provide additional insights and help you make a more informed decision.


Conclusion
Ultimately, the decision between traditional open surgery and laparoscopic repair should be made collaboratively with your healthcare provider, taking into account the specifics of your hernia, your overall health, and your personal preferences. Both methods can be effective, but understanding the nuances of each will help you choose the best option for your situation. Make sure to ask your surgeon about their recommendations based on your unique circumstances, and don't hesitate to express any concerns you may have about the risks and benefits of each approach.

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