Inguinal Hernia Repair
An inguinal hernia occurs when fat or organs from within the abdominal cavity protrude into the inguinal canal. This canal is the normal passageway for the vas deferens in men and the round ligament of the uterus for women (along with important vessels and nerves). As these structures are passing through the muscles of the abdominal wall there is a natural weakness at this point.
Inguinal hernia repair can be performed as an open procedure with an incision just above the groin crease or laparoscopically (key-hole surgery). In both approaches the hernial sac and its contents are placed back into the abdominal cavity and the hernia defect covered with surgical mesh that has been cut to the appropriate size for your anatomy. The mesh acts as a scaffold or foundation for new tissue to grow into reinforcing the strength of the abdominal wall.
Laparoscopic Inguinal Hernia Repair
- Under general anaesthetic a small incision is made at the navel and the abdominal cavity inflated with carbon dioxide, a thin tubed camera is then inserted into the abdomen
- 2 other 5mm cuts are made on each side of the abdomen just below the level of the navel
- The thin abdominal cavity lining (peritoneum) is cut to access the hernia sac (at the end of the operation this lining is used as a drape to cover the mesh protecting it from sticking to the adjacent organs)
- Important anatomical structures and landmarks are identified
- Tissue around the hernia is cleared and the hernia sac is pulled back into the abdominal cavity
- Mesh is trimmed to size and placed over the defect, it is secured in place with dissolvable tacks and glue
- Peritoneum is used to cover the mesh before all instruments are removed and the wounds closed with buried dissolvable sutures.
The advantages of key-hole repair include-
- less post-operative pain
- earlier return to normal activities and work
- ability to repair bilateral groin hernia’s at the same operation
- reduced risk of mesh infection
Circumstances when laparoscopic repair is not generally recommended-
- prior surgery in the area such as prostatectomy or previous laparoscopic hernia repair
- history of cardiorespiratory illness causing increased risk with a general anesthetic
- irreducible inguino-scrotal hernia’s
In these instances the traditional open approach will be the preferred option.
- Laparoscopic inguinal hernia repair can be performed as day surgery with a return to normal diet and discharge home the same day once recovered from the general anesthetic.
- Patients with bilateral (both sides) inguinal hernia repair will be observed in hospital overnight
- A script for pain medication will be provided on discharge
- Dressings should remain in place for one week
- Mobilisation is encouraged from day 1 however strenuous activity such as large household cleaning chores and vigorous exercise should be avoided for 4 weeks.
- No heavy lifting for 6 weeks to avoid an early recurrence of your hernia.