Laparoscopic Hernia Repair

A hernia is a bulge of the internal lining of the abdomen, often at the groin or at the umbilicus, where the bowel protrudes through a weakness or a hole in the muscle wall and could become trapped. The bulge usually becomes apparent on standing up, coughing or doing a heavy job such as lifting or pushing. The hernia tends to disappear on lying down, but may persist particularly if it is large in size. Some hernias come about slowly, others suddenly. Some are caused by excessive straining, others by obesity, heavy work or persistent coughing.

Hernias never heal by themselves. Although not all hernias cause pain, if left alone they are likely to get bigger and be at risk of serious complications. The bowel may get trapped in the hernia and could become obstructed or their blood supply may be compromised. These complications cause a serious threat to life and need an emergency open operation. With very few exceptions, all hernias ought to be repaired.

In general there are two ways for fixing a hernia; the open method and the keyhole [laparoscopic] technique. Although some surgeons use only sutures to fix a hernia during an open operation, most surgeons nowadays use a non-absorbable (prolene) mesh, as this is associated with less pain and a considerably less chance of recurrence. The mesh can also be placed by a keyhole operation (laparoscopically).

  • Keyhole hernia surgery is associated with less pain compared with open repair.
  • Patients recover more rapidly and return to normal activities, work and sports. The ‘keyhole’ approach to the operation is therefore best for patients who need to return to heavy work, exercise, or activity quickly.
  • Has less complications related to the wound, cord, or scrotum, e.g. Infection, blood clots [haematoma], or nerve irritation [neuralgia].
  • It is best for patients with hernias on both sides [bilateral] and hernias that have been repaired before [recurrent]. The mesh repair is durable.
The chance of the hernia recurring after a keyhole repair is extremely small and equal to the best open method. Several randomised clinical trials that compared the laparoscopic (keyhole) and traditional (open) methods of repair of inguinal hernias have demonstrated the advantages of keyhole over open surgery in terms of reduction in pain after the operation, and a more rapid return to full activity and employment.
  • The keyhole operation is performed under a general anaesthetic through 3 small incisions in the lower abdomen.
  • Unlike the open operation, there is no muscles cutting involved in the keyhole surgery; hence less pain.
  • The abdomen is not entered, and the dissection is carried out between the muscles and the lining of the abdomen [peritoneum], which gives the operation an added safety.
  • The hernia sac is dissected and pushed back.
  • The defect in the abdominal muscle wall is patched up with a non-absorbable [permanent] mesh, similar to patching up a tire.
  • The mesh is placed under no tension. No staples are used to fix the mesh, as these may trap the nerves and cause more pain; they have been shown to be unnecessary.
  • The skin is closed with a dissolvable suture, so no sutures need to be removed. You may therefore have a shower at any time after the operation.

All hernias could be fixed by keyhole surgery. However, huge hernias and the presence of a scar on the lower abdomen of a previous operation, such as that of an appendicectomy may cause difficulties. Patients who are not fit enough for a general anaesthetic may be advised to have an open operation, although keyhole surgery could still be preformed under a spinal anaesthetic.

You may need painkillers for the first 2 days. You could have a shower at anytime, and could discard the waterproof dressing after 7 days. The skin sutures do not need to be removed as they dissolve. Take it easy for the first week, but feel free to resume normal activity soon afterwards. Most patients return to normal within 7-10 days, and to work within 2-3 weeks. You may drive a week after the operation, and could also resume sexual activity whenever you feel able to do so. You will be reviewed in the clinic in 4-6 weeks to make sure all is well and to complete a patient-satisfaction questionnaire.

Laparoscopic techniques versus open techniques for inguinal hernia repair(Cochrane Review)
NICE: Laparoscopic surgery for inguinal hernia – Patient information sheet