Ultimately, the post-op success of your facility’s hernia repairs is contingent upon the skill of your surgeons. “The ability of the surgeon is one of, if not the single most important factor, in preventing post-op pain,”
says Dr. Voeller. And although tens of thousands of hernia repairs are done on an outpatient basis each year, the procedures require a tremendous amount of skill. “These are laborious, meticulous procedures that require an exquisite
attention to anatomical detail on the part of the surgeon,” says Dr. Mazin.
“Surgeon ability is one of the most important factors in preventing post-op pain.”
— Guy Voeller, MD, FACS
This attention to detail is absolutely critical because surgeons are operating in close to proximity to several sensory nerves. “With an inguinal hernia repair, the groin has a number of sensory nerves that are at risk during the surgery
itself or during the scarification process afterward,” says Dr. Voeller.
Specifically, notes Dr. Mazin, surgeons must be aware of where they’re operating in relation to the iliohypogastric, ilioinguinal and genitofemoral nerves, and avoid them at all costs.
In terms of technique, there’s compelling evidence that a minimally invasive approach is superior to an open one in terms of preventing post-operative pain. “Virtually every study shows that properly done minimally invasive repairs
will have less acute pain and less chance of chronic long-term pain than open repairs,” says Dr. Voeller. That’s because the way mesh is placed during open repairs can cause the sensory nerves to scar into the repair area,
which leads to a higher incidence of chronic pain.
With laparoscopic mesh placement, surgeons work behind the muscle so the mesh doesn’t sit on those nerves and there’s less chance of the nerves scarring into the mesh, adds Dr. Voeller.
So surgeons should always perform laparoscopic hernia repairs then, right? It’s not that simple. Surgeons who perform these repairs need to do a high volume of them because of the skill and attention to detail required.