European & American Hernia Societies Conference (Boston, USA)
This occurred over four days in June 2006. There were over 1000 attendees but very few from Australia.
Whilst there I met Dr Martin Kurzer of the British Hernia Centre (link). I had visited the British Hernia Centre in London on two previous occasions to observe their work and have discussions.
The British Hernia Centre carries out most hernia repairs using the open technique with a Local Anaesthetic infiltration and a mesh reinforcement. This broadly follows what is described as the Lichtenstein tension free technique. The key component is the use of Local Anaesthesia rather than General Anaesthesia. Lichtenstein popularised this technique in Los Angeles. It gives excellent results in most hands and it is very safe.
At the Conference many other techniques were also presented. Hernias worldwide have become an enormous business, as hernias are one of the commonest general surgical operations. The mesh used in the repair can cost anything between $70 – $300. In addition for laparoscopic (keyhole) expensive disposable equipment is used.
There has been intense research to develop better or alternative methods of repair for hernias. The idea is to obtain the perfect result that is no complications to the operation no pain after the operation no recurrences and an almost immediate return to work. We strive for these results.
There is no doubt that the use of mesh either by the open method, with or without plugs, or by the laparoscopic method has revolutionised hernia surgery. However, it has been suggested by some that the mesh used in surgery can contribute to ongoing.
Pain at the site of the hernia operation in a small percentage of patients and can even last for several years.
As a result companies are producing lighter weight meshes, which partially absorb. They suggest that this will reduce the incidence of pain.
Audit has shown that persisting pain in our cases has not been a common problem.
Some conference participants were concerned that altering the mesh might lead to an increase in the incidence of recurrence. We do occasionally use these lightweight meshes, but it is unclear if there is any difference in the pain post-operatively or the recurrence rate.
At the Conference acknowledged experts presented their favourite methods of repair and almost all use mesh.
Whilst it is commonplace in the US, Europe and at the British Hernia Centre to repair hernias under Local Anaesthetic and sedation, this technique does not appear to have found favour in Australia for reasons, which are found difficult to explain.
There was general agreement that the Shouldice Clinic in Canada gets excellent results using a suturing technique in layers. However, most clinics have not been able to reproduce their results.
Most agree that the Lichtenstein, British Hernia Centre technique and the method favoured by ourselves gives excellent results.
In addition there are now several techniques where the mesh is placed behind the muscles. These techniques can be used under Local Anaesthetic but more commonly require a General Anaesthetic. These meshes generally use a larger and heavy material.