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Know your options for hernia repair E
Mr Simon Marsh, consultant groin and hernia surgeon
veryone will agree that NHS staff have worked heroically throughout the Covid-19 crisis.
As (we hope) some sort of normality returns later this year, we’ll be left to deal with a huge backlog of patients needing treatment for a variety of ‘routine’ conditions. By the end of 2020, there were
more than four and a half million people on waiting lists, with over 100,000 waiting for in excess of a year (an increase of one hundred times compared with February 2020). Of these,
a significant proportion is waiting for hernia repair. Normally,
around 80,000 inguinal (groin) hernias are operated on every year here in the UK and, even before the pandemic, access to surgery in the NHS was restricted, prompting the Royal College of Surgeons and the British Hernia Society to produce a report expressing concern regarding the consequences of limiting hernia operations. While inguinal hernias have been
known about for over three and a half thousand years, not surprisingly, it was the advent of safe general anaes- thetics in the second half of the 19th century that made surgical repair
By the end of 2020, there were more than four and a half million people on waiting lists, with over 100,000 waiting for in excess of a year (an increase of one hundred times compared with February 2020)
possible. An Italian surgeon, Edoardo Bassini,
is credited with the first
effective technique, which relied on an understanding of the anatomy, and function, of the muscles in the groin. He used sutures to reconstruct the inguinal canal (the groin) after reducing the hernia. In 1945, Edward Earle Shouldice opened a clinic near Toronto that still bears his name, making hernia repair available to the general population. Using specialist surgeons, and still relying largely on the anatomical ‘shouldice repair’, this was the basic technique by which nearly all inguinal hernias were repaired until the mid-1990s, and it was the way I was taught. In 1987, Irving Lichtenstein, in Los
Mr Simon Marsh, Consultant Groin & Hernia Surgeon
Angeles, popularised his technique that used a polypropylene mesh placed on the back of the groin. He called his technique ‘tensionless’ and by the mid-1990s, it had become the most common technique for repairing hernias in the UK. As it didn’t require
detailed anatomical knowledge, it was felt to be an easier technique for an inexperienced surgeon to perform. Te advent of laparoscopic surgery,
in the late 1980s, led to another tech- nique where a very large mesh patch was placed inside the abdomen. Terefore, the majority of surgeons who trained after the mid-1990s learnt only these mesh techniques. I’m seeing an increasing number
of patients who request ‘non-mesh’ repair, particularly young, athletic men. Te Royal College of Surgeons has announced that, ‘there’s a mesh- free alternative for patients with groin hernias’, but because the current generation of surgeons may only
have learnt the Lichtenstein repair or laparoscopic techniques,
the exper-
tise to perform non-mesh, anatom- ical (shouldice type) repairs may be being lost. Having said that, it should be remembered that most hernia repairs, by whatever technique, are uneventful, but it’s important that there’s a choice. Perhaps it all comes down to the experience, and care, of the surgeon?
T: 020 7563 1234 E:
info@108harleystreet.co.uk 108harleystreet.co.uk
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