Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair

Abstract

In 1985, Medicare started an experimental study in California mandating "Same-day" herniorrhaphy for all patients unless serious medical contraindication existed. Blue Shield and Blue Cross are rapidly following suit. It is little wonder therefore that ambulatory outpatient surgi-centers are now including hernia repair in their armamentarium. Change in environmental milieu must not compromise the quality of the surgery and care of the patient. This paper reviews the author's experience with outpatient hernia surgery and introduces a new surgical concept, tension-free repair. Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage-suture line tension. This is the prime etiologic factor behind hernia recurrence. By using modern mesh prosthetics, it is now possible to repair all hernias without distortion of normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective; allowing prompt resumption of unrestricted physical activity.