Laparoscopic repair offers the advantage of smaller wounds, faster wound healing and less post-operative discomfort. Often this will allow people to get back to full activities more quickly than they would with traditional/open surgical repair.
A hernia is a protrusion of a structure through a weakness or hole (hernia defect) into the surrounding tissue.
Commonly, hernias may occur in the groin (inguinal or femoral hernias) around the umbilicus (umbilical or para-umbilical hernias) or in the upper abdomen (ventral or epigastric hernias).
They may also occur around wounds from previous surgical procedures (incisional hernias).
Hernias are often uncomfortable, causing a dragging sensation that is often worse at the end of the day, or after activity or long periods of standing.
Sometimes hernias may get stuck (incarcerated) which may lead to severe pain and may require urgent surgical repair.
For some hernias, there is a small risk that the bowel can get stuck within the hernia leading to strangulation. This requires urgent surgical intervention.
Most hernias can be accurately diagnosed based on clinical history and examination. However, sometimes an ultrasound or MRI scan may help to diagnose hernias that are not so obvious.
The aim of surgery is to repair the hernia hole or defect either with sutures or a mesh or a combination of both. The need for a mesh will depend on the size and site of the hernia and the surgical approach.
These hernias occur in the inguinal (groin) region and are particularly common in men.
For most inguinal hernias we would offer a laparoscopic (keyhole) repair using three small surgical incisions made away from the groin/hernia region.
There are two main surgical approaches for laparoscopic repair TAPP – (TransAbdominal Pre-Peritoneal repair) and TEP (Totally Extra-Peritoneal repair) – but the internal repair is almost identical for both.
Both repairs involve placement of a mesh behind the hernia defect (behind the groin muscles) which is normally secured using either specialist biological glue or small absorbable tacks.
What are the advantages of laparoscopic repair?
Open procedures may be necessary for either very large hernias or in patients who have had previous extensive abdominal surgery (where potential intra-abdominal scarring may make keyhole surgery difficult).
The open repair involves an incision in the groin directly over the hernia itself. The groin muscles are divided and the hernia defect closed with a combination of sutures and/or the positioning of a mesh on top of the muscle.
Recovery may be a little longer due to the need for the groin muscles to fully heal and patients may need to avoid heavy lifting or strenuous activities for a little longer than after a laparoscopic repair.
Most patients make a good recovery but a few patients can experience ongoing (chronic) groin pain secondary to scarring or nerve irritation within the groin muscles.
Hernias around the umbilical region are called umbilical or para-umbilical hernias.
For small umbilical hernias an open repair is often all that is needed.
This involves a small (3-4cm) incision, either above or below the umbilicus, and the suturing of the underlying muscle defect (hernia defect) with non-absorbable sutures. Sometimes, if the muscle defect is larger than about 3cm, a mesh may be positioned just behind the muscle to reinforce the repair.
For larger umbilical hernias a laparoscopic repair may be preferable to allow placement of a larger intra-abdominal mesh. This also avoids the need to make a very large incision around the umbilicus.
Laparoscopic repair is normally done using three small incisions (often in the left side of the abdomen away from the umbilicus) and a mesh is positioned under the hernia defect. The mesh is usually secured with absorbable tacks.
Hernias that develop underneath previous surgical wounds are called incisional hernias. These can sometimes be technically more difficult to repair due to general surrounding muscle weakness and may require a combination of both laparoscopic and open techniques.
A laparoscopic placement of mesh offers the usual advantages of laparoscopic repair as well facilitating placement of a large enough mesh to give adequate coverage to the hernia defect. Sometimes three or four small incisions are required directly over the hernia so that the edges of the defect can be fully or partially closed from above prior to laparoscopic mesh placement (hybrid repair).
We offer several other NHS and private surgical services throughout the Thames Valley region: