Using mesh reduces the chance of the hernia returning. Those who have their hernias repaired with mesh have less pain following surgery and return to work sooner. Using the mesh technique also allows hernias that are bilateral (on both sides) to be fixed at the same time.

The advantages of laparoscopic surgery over an open surgery are that people have less post-surgery pain and numbness compared to open or traditional surgery and are able to return to their usual activities sooner. The disadvantages are that general anesthesia is required, that operation times are longer (increasing possible complications from anesthesia) and that there is a higher risk of serious complications with laparoscopic surgery. These serious complications include injury to internal organs (particularly the urinary bladder) and injuries to blood vessels that can occur when the instruments needed for the surgery are put into the abdomen. There appears to be little or no difference in recurrence of hernias (have the hernia come back) between laparoscopic and non-laparoscopic (open) methods of repair.

The experience of the surgeon must also be taken into consideration because it relates to the rate of complications. One study (Neumayer 2004) found that surgeons who performed over 250 laparsocopic hernia repairs had better outcomes than did surgeons who had performed fewer than 250. Another study on the learning curve for laparoscopic hernia repair (Voitk 1998) found that complications and surgical times continued to improve until the surgeon had performed at least 50 operations. The bottom line is that laparoscopic hernia repair is best performed by a surgeon who is very experienced in this technique.

Some people who are not felt to be good surgical candidates (frail elderly, chronic disease, others at high risk) are fitted for trusses. Despite their use (particularly in England), trusses have not been well-studied and there is little written regarding their use. It is felt that they weaken the tissues around the hernia, and make subsequent surgery more difficult.

In a traditional repair the area around the hernia sometimes gets stretched tightly, increasing the risk that the gap will re-open (called a recurrence). Traditional hernia repair is associated with a higher recurrence rate (at least 5 to 10 percent), and more post-surgery pain that sometimes can last up to a year. Recurrent hernias and post-operative chronic pain situations usually require repeat surgery.

The basis for this recommendation is that if a loop of intestine slips through the hernia and becomes trapped, blood flow to the loop may be cut off and gangrene can set in. This complication of hernia is known as strangulation and is a surgical emergency. The lifetime risk of strangulation for an untreated hernia has been estimated at 4-6%, however this figure is based more on speculation than on clinical studies. Actual studies on populations put this risk much lower, at less than 1%. It has also been traditionally taught that, left untreated, hernias tend to get larger and thus become harder to treat. Again, this risk has not been proven by clinical studies. There is currently a study underway to compare watchful waiting to surgical repair for inguinal hernias. This study began in 2003 and will not be complete for several more years.

Using mesh reduces the chance of the hernia returning. Those who have their hernias repaired with mesh have less pain following surgery and are able to return to work sooner.

Advantages of laparoscopic surgery over open surgery include decreased post-surgery pain and numbness and the ability to return to usual activities faster. Disadvantages are that general anesthesia is required, that operation times are longer (increasing possible complications from anesthesia) and that there is a slightly higher risk of serious complications These include injury to internal organs (particularly the urinary bladder) and injuries to blood vessels. These can occur when the instruments used for the surgery are put into the abdomen.

There appears to be little or no difference in recurrence of hernias (have the hernia come back) between laparoscopic and open methods of repair. The experience of the surgeon is related to the rate of complications. One study (Neumayer 2004) found that surgeons who performed over 250 laparsocopic hernia repairs had better outcomes than did surgeons who had performed fewer than 250. Another study on the steep learning curve for laparoscopic hernia repair (Voitk 1998) found that the rate of complications and length of time in the operating room continued to improve until the surgeon had performed at least 50 operations. It's best to be sure that laparoscopic hernia repairs are done by a surgeon who is very experienced in this technique.

A traditional repair, which may include the use of mesh, is still used when a loop of intestine or parts of other organs gets trapped in the hernia opening (incarceration) if the trapped organ has not become infected (strangulation). Once strangulation occurs, the risk of the use of mesh becomes much greater. In this situation, the risk of the hernia coming back (recurring) is much greater.

The basis for this recommendation is that up to 40% of femoral hernias become strangulated (a loop of bowel becomes stuck in the hernia opening and blood flow to the bowel is interrupted with possible gangrene). Strangulated hernias are a surgical emergency and their repair carries a much higher mortality rate (up to nearly 10% in very sick, elderly individuals).

Recurrence rates (chance of the hernia returning) with the mesh technique appear to be much lower, so far compared to older methods in which the edges of the hernia openning we sewn directly together. No good long-term data (more than 4 years) is available yet for mesh repair of incisional hernias, because this technique is new. The best way to attach the mesh to the muscles of the abdominal wall is still under debate. Several methods are popular and the surgeon will choose, in part, based on the layout of the hernia. The different ways of using the mesh need to be studied further. General anesthesia and hospitalization are required for this technique.

The mesh is inserted through a laparoscope and attached to the abdominal wall. Advantages of laparoscopic surgery over open surgery include less post-operative pain and numbness and the ability to return to usual activities faster. Disadvantages are that operation times are longer (increasing possible complications from anesthesia) and that there is a somewhat higher risk of serious complications. These include injury to internal organs (particularly the bowel) and injuries to blood vessels. These can occur when the instruments needed for the surgery are put into the abdomen.

There appears to be little or no difference in recurrence of hernias between laparoscopic and open methods of repair. The experience of the surgeon correlates with the rate of complications, with more experience surgeons getting better results.

General anesthesia is required for this method (as it is for all incisional hernia repairs).

Traditionally, incisional hernias were repaired by carefully sewing together the edges of the gap. This technique has recently been mostly replaced by the use of a mesh (a cloth-like patch) which tend to have fewer hernia recurrences (returning hernias). Surgeons have tried to modify the traditional technique to decrease the recurrence rate. Changes include, for example, the use of "relaxing incisions" (small openings created to the side of the hernia repair) that decrease the tension, as well as other modifications. These modifications, however, often create other problems, so surgeons have abandoned primary closure except for unusual circumstances.

Studies show lower rates of recurrence when the mesh is placed farther into the abdomen rather than at the outer edges of the hernia as in inlay repairs.

The recurrence rates are lower, but mesh infection rates of up to 12% and long-term pain following surgery are two reasons why this technique has been replaced by other methods.

Enlarging hernias can become increasingly difficult to fix, and large hernias are disabling. Only people who are too sick to withstand surgery (frail elderly, etc) should avoid surgery.

Using mesh reduces the chance of the hernia returning. The rate of recurrence is quite low (in one well-done study less than 1%).

The advantages of laparoscopic surgery include less post-operative pain and numbness as well as the ability to return to usual activities faster. The disadvantages are the need for general anesthesia, longer operation times (increasing possible complications from anesthesia) and a higher risk of serious complications. These include injury to internal organs (particularly the bowel) and injuries to blood vessels. These occur when the instruments needed for the surgery are put into the abdomen.

There appears to be no difference in recurrence of hernias between laparoscopic and open/non-laparoscopic methods of repair. The experience of the surgeon correlates with the rate of complications. Most of the studies evaluating laparoscopic repair for umbilical hernias are not of high quality. More study and experience is needed before this technique can be definitively recommended.

This is known as the Mayo technique, originated by the Mayo brothers in the 1910s. More modern methods give better long-term results with fewer hernia recurrences (returning hernias).

In a traditional repair, the area around the hernia sometimes gets stretched tightly, increasing the risk that the gap will re-open (called a recurrence). Traditional hernia repair is associated with a higher recurrence rate that may require repeat surgery.