Hernia Treatment available in Surrey.

New techniques for repairing hernias are developing all the time making repairs easier, more effective, causing less post-operative pain and enabling quicker return to normal activity. Some of these new techniques are described below. For further information, please see our Hernia facts and information page.

1. Incisional Hernias

The most recent development for repair for this type of hernia is the Composix Kugel patch. This is a large, oval shaped mesh, lined with polypropylene on the inside, which prevents the bowel adhering to it. It is interposed between the abdominal contents and the inside of the anterior abdominal wall to which it is then stapled. It enables a tension-free repair to be done (see picture).

2. Umbilical Hernias


The newest development in the repair of these hernias is called the Ventralex patch. It consists of a fairly rigid mesh/PTFE disc the size of a 50p coin, attached to two mesh ribbons at the centre of its upper surface (see middle picture above). Once the hernia orifice has been defined the mesh disc is folded and passed through the defect (see right picture above) and then using the ribbons, pulled up on the inside of the hernia orifice. The ribbons are then stitched to the rectus sheath providing a tension-free repair.

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3. Inguinal and Femoral Hernias

The Kugel patch is the most exciting development in the repair of inguinal and femoral hernias. I believe it will become the gold standard for the repair of these hernias.

We at The Hernia Specialists use the mesh plug and Kugel patch repair techniques.

What is the mesh plug technique?


This is a procedure originally developed in the USA where it is now well established. About 50% of all hernias repaired in the USA are done using this method. A small cut is made directly over the site of the lump in the groin. A plastic mesh plug, shaped like a Badminton shuttlecock is put into the hernia defect to plug it. The hernia remains inside the body permanently to reinforce the weakened area. A small number of sutures initially hold the mesh plug in place. There is minimal discomfort and swelling. The surrounding tissue grows into the mesh plug strengthening the area of weakness and permanently holding the plug in position. The average operation lasts about 25 minutes and you will be asked to return in one week for a post-operative check. There are no sutures or skin staples to removes. The small plastic dressing is simply peeled off your wound. After this visit it is recommended that you are checked annually. Following your operation our staff will always be available to give assistance and advice.

What is the Kugel patch technique?

This is the newest advance in minimally invasive open hernia repairs. It utilises the same type of small incision used in the mesh technique. The principle behind this repair is as follows:
Think of your hernia as a bulge in a tyre. The outer wall of the tyre is like your abdominal wall. The inner tube of the tyre is like your intestine. If a weakness or break occurs in the outer wall of the tyre the inner tube can bulge through this weakness. Similarly a hernia forms in a weakness in the abdominal wall. Repairing a hernia is very similar to fixing a tyre. You can either place the patch on the outside or you can place it on the inside. This is what happens with the Kugel hernia patch. Here the patch is placed over the defect on the inside of the anterior abdominal wall, thus using the pressure of the body to hold the patch in place.

So what is a Kugel patch?

It is an oval mesh patch reinforced around the edge by a memory recoil ring, which enables the patch to spring back to its original shape once it is in place. This enables a relatively large prosthetic patch to be inserted through a small incision.

How does the Kugel patch work?

This is a pre-peritoneal repair. A 3 to 4cm incision is made over he internal ring of the inguinal canal. By sweeping pack the peritoneum from the back of the canal a space is created, exposing the femoral canal and the back of the inguinal canal. The hernia sac is reduced, whether it be a direct or indirect inguinal hernia or a femoral hernia. The Kugel patch is then placed between the peritoneum and the inguinal and femoral canals, thus preventing any further hernia forming.

This is akin to having a bucket of water with a hole in the side wall. This is then sealed by placing a patch over the hole on the inside thus using the weight of the water to keep the patch in place and the hole sealed.

Advantages of the Kugel Patch

The Kugel patch has all the advantages of a laparoscopic repair, in that it is pre-peritoneal and avoids the nerves. It avoids the main disadvantage of the laproscopic repair in that it does not require invasion of the abdominal cavity. It is also less painful than the traditional open anterior approach and enables a quicker return to normal activities.

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