Inguinal Herniae
Pre-Operative preparation:
Standard preparation for general anaesthesia.
Operation:
There are a variety of procedures possible depending upon the type of hernia and the patient’s wishes.
1: Congenital herniae require only excision of the hernia sac (herniotomy)
2: Standard open (Lichenstein) repair. This procedure involves excision of the hernia sac and strengthening of the defect by insertion of a mesh.
3: Laparoscopic repair (keyhole surgery) This procedure involves reducing the hernia sac and then inserting a mesh behind the muscle of the abdominal wall. Aberdeen Surgical use an extra-peritoneal approach (TEPPS repair). This is the procedure of choice for bilateral or recurrent hernias.
Anaesthesia:
Open hernia repairs (1 & 2) may be undertaken under local or general anaesthesia. Laparoscopic (3) repairs require a general anaesthetic.
Post Operative Care:
Day case or with an overnight stay. Generally there will not be any sutures to remove but there may be steri-strips (or paper strips) covering the wound. Laparoscopic surgery results in an earlier return to full activity than an open repair i.e it is likely that 1 week after a laparoscopic hernia repair there will be a return to full mobility and after 2 weeks everything other than strenuous physical activity will be possible. It is not uncommon to experience some swelling and bruising in the lower abdomen and scrotum after a laparoscopic inguinal herniorraphy but this is self limiting.
Following open hernia surgery a significant proportion of patients will experience altered sensation in the groin region. In a small proportion this will lead to long term pain and is due to scar tissue irritating one of the nerves in the groin region. This complication is less common after laparoscopic surgery.
All forms of hernia repair are associated with a risk of recurrence of the hernia. Modern techniques and prosthetic meshes have reduced this to very low levels.
OPC Codes:
T1900 excision of hernia sac (1)
T2000 primary repair of inguinal hernia (2)
T2002 laparoscopic repair of inguinal hernia (3).
[These codes are for unilateral primary repairs of herniae. Additional codes apply to bilateral and recurrent herniae]
