Hernia Repair Techniques and Outcomes

Hernia repair encompasses a range of surgical approaches designed to restore integrity to the abdominal wall or groin. Techniques may be broadly divided into open and minimally invasive modalities. Open repairs include suture-only closures and tension-free mesh implantation, typified by the Lichtenstein method for inguinal hernia. Minimally invasive options employ laparoscopy or robotics and can be performed via transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) access. Advanced open techniques such as component separation facilitate closure of large ventral or incisional defects. Choice of mesh material and fixation influences recurrence, chronic pain and foreign-body response. Outcomes are assessed by rates of recurrence, postoperative complications, chronic discomfort and time to return to normal activity. Day-case surgery has become routine in selected patients, reducing hospital stay without compromising safety. Emerging technologies, including three-dimensional imaging, novel biomaterials and techniques to modulate tissue mechanics, seek to improve long-term durability and patient quality of life. Global disparities in access, technique selection and outcome monitoring highlight the need for standardised definitions, registries and guidelines to inform best practice.

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Hernia Repair Techniques and Outcomes publication trend

The graph below shows the total number of articles in hernia repair techniques and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Mesh repair: use of a synthetic or biological scaffold to reinforce a hernia defect without tension on native tissues.

Lichtenstein repair: an open tension-free mesh technique for inguinal hernia in which the mesh is fixed anterior to the transversalis fascia.

TAPP (transabdominal preperitoneal): laparoscopic approach creating a peritoneal flap to position mesh behind a groin hernia.

TEP (totally extraperitoneal): laparoscopic method of repairing groin hernias without breaching the peritoneal cavity.

Component separation: open strategy to mobilise abdominal wall muscle layers for closure of large ventral or incisional defects.

Day-case surgery: operative management allowing patient discharge on the same calendar day of the procedure.

References

1. Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries. The Lancet Global Health (2024).
2. Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair – A systematic review and meta-analysis of randomized controlled trials. BMC Surgery (2017).
3. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)): Part B. Surgical Endoscopy (2019).
4. Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. Journal of the Mechanical Behavior of Biomedical Materials (2017).
5. Past, Present and Future of Surgical Meshes: A Review. Membranes (2017).