At Groin Pain Clinic, all hernia repairs and groin reconstructions are done without the use of hernia mesh.
Typical groin (from the Latin noun inguen) hernias can be simply divided into inguinal and femoral types. The inguinal hernias occur in the upper groin and the femoral hernias occur in the lower groin. The inguinal canal hernias are generally divided into indirect (or congenital) and direct (through the abdominal wall muscle or “rupture”).
Classical groin hernias start as a bulge which can often be painful which if untreated enlarge and become a serious problem if bowel becomes trapped in a hernia and cannot be reduced back into the abdominal cavity. Those small types of hernias that do not cause symptoms usually do not need to be treated surgically.
Groin hernias are investigated by physical examination and if there is any doubt about the diagnosis, an ultrasound is performed at an X-ray practice or a Hospital. If there is an obvious bulge the majority of cases can be diagnosed by physical examination alone. Sometimes progress ultrasound is required if a “watchful waiting” approach is followed.
There are not very many treatment options for groin hernias. It usually comes down to surgical repair or “watchful waiting”. Repair can be by an open incision or by laparoscopy and mesh placement. The open repair can be by mesh (Lichtenstein repair) or mesh-free repair (Moloney darn, Shouldice, Desarda or Kang). All 4 types of mesh-free repair are offered at the Groin Pain Clinic, but we prefer not to use mesh.
A mesh free repair avoids the use of mesh and is performed without mesh with dissolving or permanent sutures. The Moloney darn is the most frequently performed procedure which is also known as a “tension free tissue repair”. We have 20-year follow-up on some of these patients and have published an average 13-year follow-up. Professor Desarda has acknowledged our expertise with his mesh-free procedure and given his accreditation to perform that repair. The Shouldice repair is not performed routinely away from the Shouldice clinic and the results of 0.5% recurrence have not been able to be repeated elsewhere. A femoral hernia can also be repaired without mesh and a mesh "plug" is not necessary.
Insertion of mesh can be associated with chronic groin pain and the incidence is between 4% and 10% long-term. In such cases, the mesh has to be removed either by an open cut or by laparoscopic removal. We have recently reported to the Americas Hernia Society that mesh has been associated with tumour-like proliferations (neuromas) in the surrounding nerves which we believe is the cause of the chronic pain after a mesh repair. Hence, we avoid the use of mesh at the Groin Pain Clinic.
Surgery proceeds without complication in almost all cases. However in rare cases, complications can occur, and it is appropriate to mention some of these.