Treatments

Laparoscopic surgery was developed at the end of the 1980s and has since become the method of choice for many abdominal operations. Surgery with a laparoscope is minimally invasive and does not require a large incision. All the work is done inside the body and recovery time is faster because the skin and muscles do not have as much healing to do.

Laparoscopic hernia repair for inguinal hernias

The National Institute of Clinical Excellence (NICE) in the UK recommends laparoscopic hernia repair as an option that patients with inguinal hernia can discuss with their surgeon. There are many benefits; laparoscopic surgery means a shorter stay in hospital, less pain after surgery and you are back to normal activities more quickly.

Just like any surgery, however, there can be drawbacks. If the surgery is not carried out by an expert surgeon who does many of these procedures on a regular basis, complications are more likely.

Laparoscopic hernia repair by Mr Charles Imber

Mr Imber favours a technique called totally extraperitoneal (TEP) repair. This means that he operates using the laparoscope, and surgical instruments are placed between the skin and the body wall to repair the hernia. None of the instruments goes inside the body cavity.

This reduces the risk of complications such as bowel perforation, although it is a technically more challenging operation.

TEP hernia repairs still involve placing hernia repair mesh inside the body to support the internal organs and to prevent the hernia recurring. This type of repair is used for patients with a hernia that has recurred or for patients with two groin hernias, one on each side. Both can be repaired in the same operation.

This type of laparoscopic hernia repair can be used for midline hernias, inguinal hernias in men and femoral hernias in women.

Femoral hernia

Femoral hernia is a relatively rare hernia (only 3% of all hernias) but it is more common in women than in men. A femoral hernia is defined by its location, just below the inguinal ligament in the upper thigh.

This type of hernia is relatively dangerous because it is quite likely to strangulate. This means that the piece of bowel that pushes out through the body wall becomes pinched and starts to die. If this happens, it can lead to life threatening complications.

Any lump in the groin should be assessed by a medical professional, as soon as possible if the lump is irreducible (cannot be pushed back into the abdomen).

How is laparoscopic hernia repair performed?

The operation is usually done under general anaesthetic but you don’t normally have to stay in hospital overnight, unless your surgery is planned for late in the afternoon.

• 1A central incision is made in the abdomen to introduce the laparoscope into the space between the skin and the body wall.
• 2The instruments are then placed through two or three other ports at the side of the abdomen. These are low down and on one side for groin hernias.
• 3The surgeon uses images transmitted from the camera inside the laparoscope to push the fatty tissue and bowel that is sticking through the hole in the body wall.
• 4Hernia repair mesh is then stitched in place using stitches that dissolve over the next few weeks.
• 5The laparoscope and instruments are withdrawn and the port incisions are closed.

Possible complications during and after hernia repair

A potential complication when a groin hernia is repaired is damage to the nerves and blood vessels that supply the testicle. With careful TEP surgery this is avoided as much as possible.

Recovering from laparoscopic hernia repair

Even if you have this procedure for a complex or recurrent hernia, your recovery time will be relatively fast. You will normally only need over-the-counter painkillers for a day or two, and will be back to normal daily activities after about seven to ten days.

Individual cases vary, but a patient will normally be back at work at a non-manual job in about two weeks.