Laparoscopic Hernia repair

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Dr. Sanjay Dalmia

Posted By : Dr. Sanjay Dalmia - MS FRCS FRCS

Posted On : Oct 13, 2011 (Views : 2392)

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Laparoscopic hernia surgery



What is a hernia?



A hernia is an abnormal protrusion of part of the abdominal organs or intestines through a weak part of the abdomen. If, for any reason, there is a weak point in the abdominal wall, part of the intestines push through. You can then feel a soft lump under the skin.



Where do they occur?



The most common site is in the groin as the groin is often the weakest point of the abdomen. However, hernias can be found sometimes at other sites e g. next to the umbilicus (nabhi) or under an old operation scar.



What are the symptoms?



Soft reducible lumps are often noticed after a strain, for example, lifting a heavy object. In advanced cases lump can be present all the time. Usually, at first, the lump can be pushed back, but may come out after straining again. Coughing is a common precipitating factor. They are not usually painful but many people feel an ache over a hernia. In time they might become bigger as the gap in their muscle or ligament tissue becomes larger. Sometimes in men they track down into the scrotum.



Are they serious?



Usually not. However, treatment to fix them is usually advised for 2 reasons:




  • They may gradually become bigger and more uncomfortable.


  • There is a small chance they might strangulate. A hernia strangulates when too much intestine has come through the gap in the abdominal wall and then it becomes stuck. This cuts off the blood supply to the portion of intestine in the hernia. This can lead to severe pain, damage part of the intestines and need emergency surgery. However it is preferable to have the hernia fixed by routine rather than emergency surgery.



What are the methods of hernia repair?



The hernia can be repaired by either open or laparoscopic methods.



What is the principle of laparoscopic repair of hernia?



The same scenario can be imagined with placing a mesh on the hole where the hernia is. Is it going to be better fixed from outside or inside? Open surgery places it from outside and laparoscopic surgery places it from inside.



Why do you approach the hernia from inside?



The hernia is protrusion of the body contents through the weakness in the muscle. It is logical that something coming from inside is best dealt from inside. Also this way one does not cut and weaken the already weak muscle at the hernia site.



What are the advantages of laparoscopic hernia repair?



Laparoscopic approach has several advantages:



1. Tension free repair that reinforces the entire area ( myopectineal orifice)



2. Less dissection and disruption of tissue planes



3. Less postoperative pain.



4. Low intra-operative and postoperative complications.



5. Early return to work.



What are the methods of laparoscopic repair of hernia?



There are two types of laparoscopic Hernia repair:



(1) The Tran abdominal Preperitoneal repair (TAPP) - In this the peritoneal cavity is entered, hernia reduced and mesh placed. (2) The Totally extraperitoneal (TEP) repair - It maintains peritoneal integrity and allows direct visualization of the groin anatomy. The TEP hernioplasty follows the basic principles of the open preperitoneal mesh repair as first described by Stoppa in 1975.



What are the chances of the hernia coming back? Very small. Research has shown that recurrence after laparoscopic hernia repair is smaller than open repair.



Is it more risky? Generally not. The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure do increase the risk in certain groups of patients. Patients with advanced cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Every case should be assessed independently.



How safe is it to leave a mesh inside the body? The mesh used is the same as the one used for open operations over last 30 years. Its safety and efficacy is beyond doubt as proved by the numerous studies all over the world.



Is this all very expensive? Minimal. The cost of laparoscopic equipment and instrument that is used to fix the mesh inside can increase the cost of surgery. The slightly increased cost should be compared with the gain associated by a quicker and more productive return to work by the majority of the patients. The hidden lowering of cost is due to early return to normal activity and work.



What is the likely hospital stay? Usually 1-2 days What postoperative care do I have to take? You can do your routine household work after 4-5 days once you are comfortable. You can eat as before and generally return to work in 10-14 days depending on what you do. However you should avoid lifting heavy weights as it increases intra abdominal pressure and can harm you.



I had a hernia repair in my groin before but it has come back again? What should I do? You have a recurrent hernia. It should be quite suitable for laparoscopic repair.



I have developed hernias in both groins? Can it done by laparoscopy? Yes it can be done. Bilateral hernia is quite suitable for lap repair.


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