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Laparoscopic Hernia Surgery

Why Consider Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the abdomen through a small incision. The laparoscope is a small fibre-optic viewing instrument attached with a tiny lens, light source, and video camera.

About Laparoscopic Hernia Surgery

Laparoscopic surgery is performed in a hospital operating room under general anaesthesia. The procedure involves the following:

  • A camera attached to the laparoscope displays the image of the abdominal cavity on a screen.
  • The surgeon makes three small incisions over the abdomen to insert the balloon dissector and trocars (keyholes).
  • A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision.
  • Once the trocars (key holes) are placed, the keyhole instruments are then inserted to repair the hernia.
  • A sheet of mesh is inserted through the top keyhole and positioned and fixed in the abdominal wall to reinforce the repair and help prevent recurrent hernias. After completion of the repair, CO2 gas is evacuated, the trocars are removed, and the tiny incisions are closed and dressed with a sterile bandage.

Indications and Contraindications

Indications for laparoscopic hernia repair over open repair may include recurrent hernias, bilateral hernias, and the need for earlier return to full activities.

Contraindications specific to laparoscopic hernia surgery include non-reducible inguinal hernia, previous peritoneal surgery, and inability to tolerate general anaesthesia.

Medical conditions including upper respiratory tract or skin infections and poorly controlled diabetes mellitus should be fully addressed, and the surgery should be delayed accordingly.

Advantages Over Open Surgery

The advantages of laparoscopic hernia surgery over open surgery include:

  • Less post-operative pain with smaller incisions and faster recovery
  • No further incisions required for patients with hernias in both groins (bilateral hernia)
  • Ideal method for patients with recurrent hernias after previous surgery
  • Early discharge from hospital
  • Earlier return to work

Complications with Laparoscopic Hernia Surgery

Specific complications of laparoscopic hernia surgery may include

  • local discomfort and stiffness
  • infection
  • damage to nerves and blood vessels
  • Bruising, and blood clots
  • wound irritation
  • urinary retention

Post-operative Guidelines

Below are listed some of the post-operative guidelines following laparoscopic hernia surgery.

  • Pain medication will be provided and should be taken as directed.
  • Remove the bandage after 24 hours.
  • See GP for wound review after 5 days.
  • Swelling in the groin, at the site of hernia may occur due to serum accumulation in the cavity left by reducing the hernial sac.
  • Bruising usually appears in the genital area, which is not painful and disappears over 1 - 2 weeks.
  • You are able to drive usually in 1-2 weeks’ time and resume normal activities when comfortable, unless otherwise instructed.
  • Make a follow up visit approximately 2 weeks after surgery to monitor your progress.

The most commonly used laparoscopic surgical techniques for hernia repair are:

  • Transabdominal preperitoneal (TAPP)
  • Totally extraperitoneal (TEP) repair

TAPP Repair

This minimally invasive surgical procedure is performed under general anaesthesia. Your surgeon makes a small incision beneath the navel. A needle is inserted through the incision and the abdomen is filled with gas. This allows your surgeon to view the internal organs clearly. The needle is removed and a camera is inserted through the incision. Further, 2 more incisions are made near the navel to introduce the surgical instruments. The peritoneum (a membrane that lines the abdominal cavity) is cut and the hernia sac is removed carefully. A synthetic mesh is placed over the peritoneal opening and then closed with sutures.

The disadvantage of the TAPP procedure is it can cause injury to adjacent abdominal organs. The advantage of the TAPP procedure is that it can be performed on patients who have undergone previous lower midline surgery.

TEP Repair

This procedure is also performed under general anaesthesia. Your surgeon makes small incisions below the navel. A balloon is placed in the preperitoneal space (space between the peritoneum and anterior abdominal wall) and filled with gas to separate the layers. The camera and the surgical instruments are passed through the incisions. Your surgeon exposes the hernial sac, repositions it and seals the hernia with a synthetic mesh. The incisions are then closed with sutures. The mesh slowly gets incorporated with the tissues of the abdominal wall. The advantage of the TEP procedure is that it prevents the risks associated with damage to the internal organs as it is performed outside of the peritoneum.

As with all surgical procedures, TEP and TAPP hernia repair may be associated with certain complications, which include infection, bleeding, swelling and damage to the adjacent organs.