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Hernia repair surgery in NHS England

Of the 80,000 annual inguinal hernia operations in the NHS England, the vast majority follow the 'Open Mesh' technique (95.9% according to NICE¹). Just 4.1% use the Laparoscopic (keyhole-type) technique.

Numerous studies have compared the clinical outcomes of Laparoscopic (keyhole-type) surgery to 'Open Mesh' but there are often counter-studies that contradict previous findings so what is best for you will be dependent on a number of factors.

Not least of these is the experience of the surgeon(s) in your Clinical Commisioning Group (CCG) area and their expertise in a particular technique which is a major factor in a successful outcome. (This is particularly true with Laparoscopic which is technically harder).  As a benchmark the NHS UK average, per surgeon is thought to be 21 inguinal hernia operations per year. Read the herniaoutcomes.org report on this.

The age and fitness of the patient are also influencing factors for which technique is recommended by your GP / Surgeon as is the predominant procedure in your locality.

A summary of some non-contentious and general points about the differences....

Procedure NHS Cost  Associated with Technique
Laparoscopic (TEP/TAPP) £1078 Very active patients, less site damage (smaller cut), faster recovery time, more likely for bilateral hernia or recurring hernia. Requires more surgical expertise. Small risk of creating incisional hernia in wound site. herniorrhaphy
Open Mesh £987 The mainstream choice, also more suitable for elderly patients, shorter operation time, less serious complications. hernioplasty

While the operation cost partly supports why 'Open Mesh' is the more dominant process, a quicker average recovery time for Laparoscopic surgery essentially evens up the cost.

¹ Source: NICE Guidelines TA83

More information is available at the British Hernia Society
     British Hernia Society
            Hernia Outcomes Group

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Inguinal Hernias Mesh-Free Hernia Repair My Hernia Op The Anatomy of Stretching Core Strength Training


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