A doctor who suffers from a condition may not wish to undergo the same procedure he offers to his patients
I will opt for Lap ,that is what I practice.I will choose the surgeon like most patients are doing now a days.
For unilateral hernias, I will almost always choose an open mesh repair. I don't think the difference in patient discomfort justifies the added expense. For bilaterals, different story, I think Laparoscopic is the way to go.
Tricky question. Based purely on evidence, indeed laparoscopic repair has certain advantages over the open repair. I would choose the lap, mainly because i am convinced that preperitoneal placement of the mesh is better in terms of anatomy.
I totally agree with Dr Reddy, my first priority would be to choose a "good" surgeon. Now, what is a good surgeon?
Among other qualities, I think a good surgeon is someone who knows their limits, and does a meticulous job, with proper attention to detail. Open or lap, they both have pros and cons, and in the hands of experienced surgeons are proven to be equally effectv
In the UK NICE guidelines recommend that lap repair should be for bilateral hernias or recurrent inguinal hernias. Nothing wrong whatsoever with a good open repair for a single side first time inguinal hernia (and it's a good training operation for the juniors)!
This question specifically asks the procedure you would like to have done on yourself not which is a better procedure.
I prefer open surgery. Unless recurrent and bilateral inguinal hernias laparoscopy unnecessary.
Nice guidelines are outdated in my opinion. I think if the surgeon is well versed in doing TEP repair then doing laparosopic hernia repair is the way forward.
I agree that the most important thing is to choose your surgeon. As surgeons ourselves it is easy to decide what you want before you even get to see your surgeon. Taking the advice from a surgeon that you respect and trust enough to operate on you is more important than type of procedure. They will be impartial and objective.
As a surgeon, I would pick open. But hose choosing laparosocpic may want to look at a large (4500 participants) retrospective study done by the swiss comparing TEP versus TAPP http://www.ncbi.nlm.nih.gov/pubmed/22956012
I prefer open surgery, unless recurrent or bilateral.
but , choosing a good surgeon is the most important.
I'll choose the laparoscopic technique. If I believe that is the best and realize in my patients .... I can not choose a different technique to realize that ... this is not ethical or correct !!!
Probably laparoscopic, but depends of the size of hernia and if it is complicated or not.
In general -pen repair, but is depending of size of hernia, local complcations, age of patient and presence of comorbidities, especially cardiovascular.
I strongly prefer the new ONSTEP procedure for unilateral inguinal hernias. It is quick to perform, with minimal postoperative pain, fast return to normal activities and an excellent cosmetic result. All patients are very satisfied. My personal experience was recently published, please take a look: https://www.researchgate.net/publication/270882247_The_Open_New_Simplified_Totally_Extra-Peritoneal_%28ONSTEP%29_Inguinal_Hernia_Repair_Initial_Experience_with_a_Novel_Technique
Dr. Marinis
Article The Open New Simplified Totally Extra-Peritoneal (ONSTEP) In...
For unilateral inguinal hernia, i do open tension-free mesh repair. Laproscopic TAPP repair if it is a recurrent one.
Absolutely open tension-free repair using a PHS (prolene Hernia System) prosthetic device.
I've done this in over thousand patients with very good result. Low recurrences (about 1.5%) and Low incidence of mild to moderate post herniorrhaphy pain.
Tension free en mesh repair are the key words. The surgeon should use the access route he knows best.
Should the foreign (mesh) body be used on the "simple" inguinal hernia?
In one of the last publication of the shouldiceclinic a recurrence rate of more then 10 % was seen in the review population( which was less then 70%). This means that the actual recurrence rate will be much higher probably.
The recurrence rate with a mesh implant is less.
Open or laparoscopic ? TEP is my kind of preferred operation. So, if the patient comes in my hands, I will do a TEP-procedure by an unilateral hernia. I can imagine if the patient comes by an other surgeon, who's doing only open hernia-repair. He will operate with the technique that he's doing the best !!! So the choice of threatment (open or laparoscopic), depends on the experience of the surgeon. The surgeon is responsible to do an operation with a minimum on complications and recidiv ratio. To me it's the TEP, for another sirgeon it's another technique.
I would prefer the lparoscopic TAPP-procedure, performed by an experienced laparoscopic surgeon.
Open or laparoscopic?
I have experience with both techniques for over 20 years.
In unilateral inguinal hernia I used open mesh, Lichtenstein ambulatory
Thank you fellow researchers for your comments. The question specifically asks as to your personal preference when it comes to YOU needing the procedure and not necessarily which is a better procedure or what you routinely offer to patient. Indeed it makes interesting reading to note the wide range of responses. There seems to be a consensus that one would choose the surgeon carefully. Obviously this may be possible for doctors who may possess 'inside' information and this may pose a dilemma for patients
Ofcourse open repair. We advise open repair for bilateral hernias also. If you are interested in mesh free inguinal hernia repair then visit www.desarda.com
I would prefer open repair . Laparoscopic for either bilateral or recurrent hernia
For unilateral inguinal hernia I prefer to do open approch. Lichtenstein's procedure with implant of Polipropilene mesh togheter ricovery in Day Surgery. Today I think it's better way to treat inguinal hernia
I underwent open under LA in the evening and went to hospital as usual the next morning. Thank You
open surgery in unilateral inguinal hernia is a satisfactory procedure with a very high success rate
I reserve laparoscopic repair to bilateral hernias, recurrent hernias or hernia repair during other laparoscopic procedure. In other situations I am out of nationale guidelines and I need an express request of the patient (essential under a legal point of view)
Open surgery with light weight mesh done under local anaesthesia is quite satisfactory.
Anterior way, open prosthetic repair. In case of unilateral hernia of the athletes, laparoscopic repair may be an option.
I provide a very thorough information (both verbal and written) to my patients regarding the pros and cons of both types of repair i.e. open and lap for unilateral hernia and let them decide for themselves. The other factor which is important in deciding the type of repair especially in private practice is that of cost. Without a doubt open repair is far more inexpensive compared to its laparoscopic counterpart. I think most patients are wise enough to choose their repair once they have been provided a reasonable amount of information preoperatively.
unilateral inguinal hernia today in modern era it is make open prosthetic repair tension-free in local anaesthesia in day-surgery only the patient lives a long time from Hospital then in day hospital
NICE guidelines were announced long ago and since then lot of water flown under the bridge.Now there are more good(Experienced) Lap surgeons all over the Globe.
Prasanna, The question is not about the merits of each approach . It specifically asks your personal preference if YOU had a unilateral indirect inguinal hernia bearing in mind that open surgery can be done through minimal incision under LA as day case with excellent pain relief and early return to work. Whilst you may say you will choose your Surgeon that option is not available to all.
Dhiren,If this question was asked a decade ago the standard answer was open repair.Now in this part of the country all Medical college Hospitals also have MIS dept with a Prof in charge.Let us leave the merits and demerits.Iam not denying what you have mentioned which is absolutely true and doable by all surgeons.
Our guidelines still say open inguinal hernia repair for a unilateral hernia. For me personally I would (marginally) prefer to undergo a lap repair after balancing out my perception that chronic groin pain is less but recurrence rate (may be) marginally higher.
Ethically both are very successful, evidence based well tolerated procedures so I don’t see a problem with a pros / cons discussion with the patient
Thank you so much for your Q. If I don't have a good laparoscopic facilities, sure I will go through open repair and vice versa
The answer is not that simple because there are variety of factors that could affect your decision. We all know the advantages of Laparoscopy in general. In pediatric hernia repair it gives you the opportunity to diagnose bilaterality if it's not preoperatively rolled out either clinically or by US scan, it preserve the inguinal canal anatomy.
It all depends on availability of laparoscopic facilities. This would be at an added cost and is not widely available. I would still go for open tension free repair. It’s quicker, cheaper and effective with regards to outcome.
It depends on the hernia. If it is a reducible one probably I will choose a laparoscopic repair but for a large scrotal or irreducible one, the open anterior approach is my favourite. The patient is also important in this equation and matters if he is a hard worker to whom I will offer a quick recovery. Last but not least the most usual approach for the surgeon is the best option for surgery. the outcome is more important than the way it is achieved.
