Patients have different anatomy, and their hernia problems differ by size and location. Some patients may be more susceptible to recurrence because of age, occupation, activities, body habitus, collagen disorders and smoking. Although a single technique can be used to repair all different types and sizes of inguinal hernias, the choice of procedure for an individual patient should be based on the anatomical findings and the needs of the patient. There are many techniques for inguinal hernia repair. Our method of selection of the technique for inguinal hernia repair has been modified over the past twenty-five years, according to our experience with established procedures and available mesh devices.
Our initial procedures of choice were suture repairs, with classic Bassini or McVAy repairs. In the 1980’s the Shouldice technique, with a slight modification substituting polypropylene instead of wire sutures, was frequently used. The major change in our approach occurred in the 1980’s with the popularization of mesh techniques, including the umbrella plug, plug and patch, and Lichtenstein repairs were used in the eighties and nineties.
In 1998, the Prolene Hernia System was designed by Dr. Gilbert at the Hernia Institute. The Gilbert repair, which is used world-wide, became our primary hernia repair technique. Over 12,000 repairs were done at HIF between 1998 and 2014, with a recurrence rate of less than 0.5%. Since 2006, the Lichtenstein technique, using a single patch of lighter weight mesh, has been used in certain cases, with equivalent results.
With the introduction of mesh, we have achieved success in prevention of recurrences. More attention is now being given to other consequences of hernia surgery, including quality of life issues including chronic pain. Our focus has been to modify our technique selection according to the needs of the patient. Our choice of technique in the individual patient depends on type of defect, the general condition of the patient, and the patient’s needs. Because of our success with PHS repairs, it remains our procedure of choice for the majority of patients, particularly for large hernias and in patients returning to work where repeated lifting is required, or for patients planning to return to other strenuous athletic activities. Sometimes patient characteristics and needs will result in recommending a Lichtenstein repair, and rarely a suture repair. Our results with these procedures are equivalent, with very few recurrences, and minimal chronic pains issues.