Repair of an initial reduced inguinal hernia; with hydrocelectomy in a patient who is 28 months of age cpt code
An inguinal hernia is a defect in the opening of the musculo-tendinous opening of the abdomen. [ It can be due to a tear ("direct", the less common type), or due to a stretching of a normal orifice (the inguinal ring) through which the scrotal cord naturally passes ("indirect", the more common type).
The hole must be closed (in the case of a "direct" hernia), or tightened back to its normal
small dimension (in the case of a "indirect" hernia).
Older methods of inguinal hernia repair involve mobilizing the tissues that surround the hole and bringing them together under tension, holding them together with sutures. These methods (which include the Bassini (and modified Bassini), McVay, and Shouldice methods), have a high incidence of recurrence (variably between 8 and 20%) due to the tension of tissues pulling at the sutures. Such tension causes the sutures to erode through tissues (much as a wire cheese cutter cuts through cheese), which is the eventual cause for recurrence.
"Tension-free" methods include patching the holes with a piece of plastic mesh (and, experimentally, with bio-mesh materials), plugging the hole with a piece of plastic, or both.
Plastic mesh sheets can be placed from the outside (open Lichtenstein method) or from the inside (laparoscopic method). A single sheet of a plastic patching mesh has a higher risk of recurrence than using a method that involves a combination of both plugging the hole and patching it as well. This is because the sheet of plastic can "wad up" into the hole, can pull loose from the edges, and can shift position (sliding sideways so that the hole is again exposed).
Securing a large plastic sheet in an attempt to avoid this is necessary, but placement can involve a wide area of dissection and therefore increased post-operative pain. Furthermore, laparoscopic methods involve securing the mesh with staples close to critical nerves and small blood vessels; the complication rate of laparoscopic methods can be as high as 30% because of this. ]
There are no new answers.