to admit the patient to hospital, for a few days and, under general anaesthesia, the surgeon would push back the bulge of peritoneum through the opening and then close the defect by stitching one side firmly to the other. Because the patient depends upon this stitching for the rest of his life to hold the abdominal wall closed, the surgeon would normally have to place several stitches, under a degree of tension in the deep tissue, repeating the process until he is satisfied that the join will hold.

Unfortunately, this stitching distorts sensitive tissue. This will cause tension and subsequent pain with all movements (including coughing and sneezing).

The patient can expect to feel the results of the stitching long after he leaves hospital. He is therefore restricted in physical activity for some weeks.

A further problem of this technique of hernia repair is that a significant number of cases (estimated at up to 10 percent or more of all cases) will recur by virtue of the internal scar tissue becoming pulled out at some time in the patient's life. The repair of this recurrent hernia is therefore a larger operation than the first and the results proportionately more uncomfortable.

In order to reduce the tension of the stitching, surgeons developed methods of stitching the tissue in layers, one above the other. This technique reduced a little of the pressure, but resulted - by definition - in more stitching through the patient's tissue.

Later techniques involve placing or stitching a 'patch' over the hernia, it having already been stitched together, or stapling, or otherwise closing the defect.

 However the stitching is done, tissue distortion is inevitable with consequent pain for the patient.

This approach is rather more technically difficult for surgeons to perform successfully and without accidents than other techniques.

The sole advantage of this technique is that only the smallest of incisions are required (so-called "Keyhole" surgery).

Because the surgeon works 'remotely'  with these instruments and guided only by what he sees on a TV screen, he has less control than otherwise, particularly with difficult or complex cases. There are many reports of serious accidents to neighbouring organs.

The repair is achieved by firing a staple gun through mesh into the muscle tissue. This technique is performed under general / spinal anaesthesia.

Under local anaesthesia, a small incision is made over the site of the hernia. The peritoneal bulge is returned to where it belongs, as before, but the repair is achieved by placing a piece of fine (inert and sterile) mesh at the opening in the tissue. This is firmly held in place and the outer incision closed. The whole operation takes minutes to perform.

Unlike other techniques, even those now using mesh, our approach does not require any stitching together of the muscle tissue at all, thus eliminating the tension induced by other methods.

The healing process starts to take place immediately in that - sensing the presence of the fine mesh - the muscle and tendon send out fibrous tissue which grows around and through the

It is not a 'patch' stuck on the outside, but a total, tension-free reinforcement inside the abdominal wall.

The results are also similar to the concrete analogy, in that the 'mechanical load' is spread over the whole area, precisely at the area of weakness, rather than on high pressure points of stitching through the deep, sensitive tissue with older methods. When performed correctly, this technique requires no bed, even after the operation. The patient is able to walk away from the theatre immediately after surgery. 

The technique was originally devised as a much-needed alternative to re-stitching failed hernia operations (ie recurrences) done the old way. It was then realised that, as the technique was so very successful with recurrent hernias, it should be used for 'first-time' repairs and thus avoid recurrences altogether. 

We all differ in our recuperative powers but it is quite typical for a patient, after as little as 45 minutes, to be able to get up, go up and down stairs, go for a walk, even ride an exercise bicycle, and not need any bed-rest at all.

After ensuring that the patient is well enough, he leaves for home. Patients are often able to go for a gentle jog the day following the operation and steadily get back to normal routine. Indeed, we encourage as much activity as is comfortable as soon as possible.

A significant number of patients does not need to take any pain-killers whatsoever after leaving the centre. There are no stitches to be removed and no special medical or nursing after-care is needed.

What is the recovery time?

In any event, the recovery time for each individual can be expected to last a fraction of the time it takes elsewhere and with the older methods. (See the graphic comparisons of results later in this information.)

What of post-operative problems?

After - Care

In our experience at the British Hernia Centre, it is very rare indeed for us to have such difficulties. Of the many thousands of cases we have seen so far, we have been able to treat almost every single patient, including several who had been turned down as 'unsuitable' by others.

• a) the avoidance of general anaesthesia is preferable in older patients

              and
• b) the dramatically reduced loss of fitness afforded by the faster recovery time is of great value.

Total costs, including all consultations, examinations, the procedure and all after-care can be far less expensive than is often the case for LESS acceptable techniques elsewhere.

The much earlier return to work achieved by this technique is also a factor, in that any loss of earnings from a protracted period of recuperation is greatly reduced. Similarly, the avoidance of recurrences represents an even greater potential saving of both time and money.

By adopting a sensible pricing policy and by using the latest Day-Case treatment techniques, we can offer first-class expert private surgical care at prices far lower than otherwise available. For patients without private health insurance, this brings quality private treatment well within reach and without long waiting lists.