By Dr. Paulo Vieira de Sousa
Inguinal hernia is one of the most common surgical problems in both men and women and appears at all ages.
Although it’s considered by some doctors and patients as “not a big problem” it’s an annoying disease that can cause major limitations and severe medical problems on a long term basis.
A diagnosis is easily reached, with the most common symptoms being pain, or a lump in the inguinal region, which is aggravated by physical effort, coughing or sneezing.
In the long term, these symptoms can be aggravated by incarceration of the hernia (this means that the protruded hernia can’t recede back into the abdomen) or even strangulation (when the opening of an incarcerated hernia becomes too narrow, causing strangulation) compromising the vascularisation of the hernia, causing ischaemia and gangrene.
At this point, treating a hernia is an emergency procedure that may require bowel resection and can cause peritonitis, sepsis and death of the patient. So, although initially it is not a major medical problem and not an emergency situation, in the long run, and if not treated, it can develop into a serious medical situation.
Treating hernias has been a challenge for surgeons throughout the ages. The first reported surgery was carried out in Egypt a few centuries ago.Several ‘non surgical’ approaches have been tried without success.
Hernia surgery has became the most performed surgery worldwide, and the most recent surgical techniques involve the placement of a mesh in the inguinal area to reinforce the damaged area, treat the fibromuscular defect and prevent the recurrence or appearance of new ones.
Ever since mesh has been applied in hernia surgery, at the beginning of the 80s, the recurrence of inguinal hernias has dropped to residual figures.
But not all the mesh repairs are the same … these days the major difference is between open or keyhole repair (laparoscopic or video surgery).
Although all studies point to equal long-term results and recurrence prevention, the immediate outcome after surgery is totally different, depending on which type you opt for.
Open repair has some advantages, as it can be performed under local anaesthesia, takes a shorter time and is less expensive. But TEP repair is less painful, allows for a faster recovery period and a quicker return to normal daily activities; sport and work.
If aesthetics is a concern, then there’s no doubt that TEP repair is a better option as only three tiny incisions of 5mm and 8mm are visible after surgery and these are hidden in less conspicuous areas of the body.
This surgical approach is the most demanding technique of hernia treatment and is mainly performed in highly specialised hernia centres worldwide.
TEP repair has started to be performed in the HPA group, both in Gambelas and Alvor hospitals, and soon it will also be carried out at the clinic in Guia.It is a day case type surgery, allowing the patient to return home safely at the end of the day.
Dr. Paulo Vieira de Sousa is a general surgeon and clinical director at the Hospital Particular do Algarve in Faro, specialising in local and keyhole surgery. He was a former assistant surgeon at the Hospital Egas Moniz in Lisbon and assistant of the surgery department at the Medical University of Lisbon.