Hernioplasty

Hernia repair is an effective treatment, yet hernias have a notable likelihood of recurring. To significantly reduce this rate, surgeons often strengthen the repair using a surgical mesh in a procedure known as hernioplasty.

What Is Hernioplasty?

A hernioplasty, or mesh repair, aims to repair herniated tissue and fortify the weakened area. This procedure involves pushing the organs back to their original position and adding a synthetic or biologically derived mesh for support. The sterile mesh is placed across the surrounding healthy tissues to strengthen the area and reduce the chance of future complications. It is commonly used to address various types of hernias, especially inguinal hernias.

When Is Hernioplasty Recommended?

While not all hernia repairs require mesh, hernioplasty is generally preferred to reduce the risk of recurrence by providing long-term reinforcement to the affected area. This procedure may also benefit patients with connective tissue disorders like Marfan or Ehlers-Danlos syndrome.

However, hernioplasty may not be suitable for infected sites, as the mesh is a foreign material that can sometimes trigger an immune response from the body. This can potentially lead to rejection of the implant and require additional surgery.

What Are the Different Types of Hernioplasty Procedure?

There are several types of hernioplasty surgeries depending on the hernia’s location, size, complexity, and the patient's overall condition.

Open Hernioplasty

This traditional approach is performed through a single, larger incision directly over the hernia site. It is commonly used for large or complex inguinal, umbilical, or incisional hernias. However, open hernioplasty may result in longer recovery time and slightly greater discomfort compared to minimally invasive methods.

Laparoscopic Hernioplasty

This is a minimally invasive technique performed through small incisions using a thin tube with a camera called a laparoscope. The procedure offers several benefits, including smaller scars, less pain, faster recovery, and quicker return to normal activities. It is best used for bilateral inguinal hernias or recurrent hernias.

Robotic Hernioplasty

A technologically advanced variation of laparoscopic surgery that uses robotic arms to perform the procedure. Similar to laparoscopic hernioplasty, it involves small incisions and a laparoscope but with enhanced 3D visualisation and robotic tools. The robotic system offers finer control for greater precision but can be more expensive than laparoscopic or open surgery.

How Should I Prepare for the Procedure?

Preparation for hernioplasty involves a comprehensive approach to ensure a smooth surgery and recovery process.

• Inform your surgeon about all medications and supplements you are currently taking, as you may be advised to temporarily stop taking certain medications that can increase the risk of complications.
• Avoid strenuous activities that put pressure on the hernia.
• Stop smoking and avoid alcohol for several weeks prior to surgery to reduce the risk of complications and aid in recovery.
• Do not eat or drink anything for at least 6–8 hours before the procedure.

What to Expect During the Procedure

The process of hernioplasty varies slightly depending on whether the approach is open, laparoscopic, or robotic. It typically takes 45 minutes to an hour for simple cases, and up to 5 hours for complex ones.

• Anaesthesia – To ensure patient comfort, either general or regional anaesthesia will be administered, depending on the complexity of the surgery.
• Incisions – Open hernioplasty involves one large incision, while laparoscopic and robotic approaches use several small incisions for a minimally invasive procedure with specialised instruments and a laparoscope.
• Repair – Once the herniated tissue or organ is identified, it is pushed back into the abdominal cavity. Depending on the case, it may also be tied off or removed.
• Reinforcement – A synthetic mesh patch is then placed over the weakened area in the muscle or tissue wall where the hernia occurred. When the mesh is secured, the incision is then sutured or stapled.

What to Expect After the Procedure

After hernioplasty, patients are closely monitored in the recovery area. Here is what to expect during your recovery:

• Discharge – Patients undergoing minimally invasive procedures can often go home the same day. However, those who have had open hernioplasty typically require an overnight hospital stay for observation.
• Pain Management – Doctors usually advise using over-the-counter pain relievers to manage mild to moderate postoperative pain and discomfort.
• Postoperative Instructions – You will receive detailed instructions on wound care, activity limitations, and follow-up appointments to ensure a successful recovery. Adhering to these instructions is crucial for the best possible outcome and to reduce the risk of complications.
• Return to Activities – Most patients can return to normal activities within 4–6 weeks, depending on the type of surgery and individual healing.

What Are the Risks and Complications of Hernioplasty?

Like all surgeries, hernia repairs carry some risks. These may include infection, recurrence, bleeding, adhesions, fluid buildup (seroma), or, rarely, perforation. When mesh is used, there is also a small risk of it migrating or shrinking, which can contribute to other complications.

That said, hernioplasty is generally safe, and most patients recover well without serious issues—especially when the procedure is performed by an experienced surgeon.