Open Surgery

It’s called ‘open’ because a cut is made on the skin, more or less over the hernia. The cut need only be 6 or 7cm long – but will have to be longer if you are a little overweight, and hence fairly ‘deep’.

The traditional ‘stitched’ or ‘sutured’ repair was done through an open approach, though nowadays mesh is almost always used.

If you are having a local anaesthetic , it’s the open operation that will be used. The British Hernia Centre has a lot to say about its open ‘tension-free’ mesh repair – which it calls the preferred method – and it gets terrific results.

The open mesh repair has a lot of advantages. It is relatively straightforward to learn, and it is safe. You aren’t inside the body as such, just repairing a hole in the abdominal wall.

A Californian surgeon, Irving Lichtenstein, developed and really popularised the open mesh repair, and obtained fantastic results, so the basic form of the ‘tension-free’ repair is often called the Lichtenstein repair.

As with most things in life, when done well it gives excellent results. It is safe and can be done with a local anaesthetic.

So it is ideal for elderly or medically unwell people, people with bad hearts, poor breathing etc. But I use it in almost all of my patients, whatever their age or medical condition. In my hands it gives excellent results with virtually no problems.

The keyhole surgeons say the open repair gives more early post-operative pain, but in my personal experience this is only by 2 or 3 days.

Ideally, find a surgeon who is happy to do it using local anesthetic – it is an indicator that he is a fairly experienced hernia surgeon.

This is what the mesh placement looks like when covering the hernia and the whole of the inguinal canal (on the right in this diagram).