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What's the best hernia repair? 8/23/2011 3:10:44 AM
A laparoscopic hernia operation seems sexy and we're told it's less painful and better all around. You had better make sure you know the inside story. Because not all surgeons have the proper lap hernia training. The history of hernia repairs is the story of improvements in the field of surgery writ small. But not too small. From the days of 'taxis' or hanging hernia sufferers uopside down to let gravity reduce the lump, right up to today's mesh repairs done either open or laparoscopically, controversy has ruled the hernia roost. A majority of hernias are repaired using the traditional open (through an incision) method. About 15% are done laparosccopically.
The real problem is that we don't really know how many lap hernias a training surgeon needs to do before he or she can be considered competent. What we do know is that some surgeons are innately talented while others just aren't when it comes to the delicate touch needed for laparoscopic surgery. And the numbers don't lie.
Here are the numbers: surgical residents do about 10 laparoscopic hernia repairs in their 5 years of training. Some trainees do fewer. It has been estimated that it takes 50 to 100, maybe even 200 lap hernia repairs with supervision before a surgeon is considered competent. Seems like a lot. But the operation is very challenging.
Ask your surgeon how many he or she has done. How many in a year on average. If it's only a dozen or so, that may not be enough.
You don't necessarily need to go to a special hernia clinic for your repair. There are superb specialty hernia centers around the country. But there are also many talented surgeons in big and small hospital who can do the operation. And, of course, most of them can do a slick open mesh repair as well. the learning curve for a Lichtenstein mesh repair is about 30 cases by comparison.
The huge problem with any hernia repair is post-operative chronic pain. Sometimes the three nerves in the groin may have to be removed (called a triple neurectomy) if severe groin pain reults after a hernia repair. Ask your surgeon what particular maneuvers he or she will do to prevent the possibility of post-op pain.
At about a year after the operation, the results of most repairs are the same.
