Laparoscopic Groin Hernia Repair
Hernias are defects and areas of weaknesses in the abdominal wall. These typically occurs in the groin area and appears as a soft bulge due to the protrusion of bowel and abdominal cavity contents through this defect. This swelling is small in the beginning and can be pushed back on lying down. With time, however, the hernia invariably gets larger and may become “irreducible”. When this happens, complications can occur when the blood supply to the hernia contents get cut off.
In the beginning, the hernia may be small and totally asymptomatic. It may not require surgery at this stage but over time it will get troublesome. The hernia will not get smaller on its own. When they become symptomatic, they can cause discomfort or a burning sensation. Surgery is advisable to avoid complications from occurring. There is no other alternative treatment besides surgery. Using a hernia belt (truss) was common in the past, but we now know that this causes scarring and will eventually fail when the hernia becomes too large to be contained.
There are many ways of performing hernia surgery. All the procedures are similar in that they involve identification of the hernia sac, reduction of the contents back into the abdominal cavity and a reinforcement of the muscular defect with an inert prosthetic mesh.
For many years, the only way we could do this was with a conventional open operation. This requires a long incision that cuts through all the muscle layers. Recently, however, we have been able to do this using the laparoscopic approach.
In the early years when we started doing the laparoscopic repair, we had to insert the telescope into the abdominal cavity (the Trans-Peritoneal Approach) to perform the operation from inside. This has certain drawbacks; hence we now use a newer technique which does not require entry into the abdominal cavity (the Extra-Peritoneal Approach). The telescope and 2 fine instruments are placed in the space behind the muscle layers and the whole operation is performed using these keyhole incisions.
Since only keyhole incisions are used and a long muscle cut avoided, the post op pain is reduced and the return to function is rapid. Our patients are admitted on the day of surgery, and can go home after the operation (i.e. Day Surgery). Older patients may require a night’s stay for observation. This operation is usually done under General Anaesthesia.
The laparoscopic repair is definitely superior to conventional open surgery if you need surgery on both sides at the same time (i.e. a bilateral hernia), or if you already have a previous open repair which has failed (i.e. recurrent hernia). We also recommend the laparoscopic approach for patients who are young or those who are active in sports, have a physically demanding job, or simply want a better functional outcome after surgery. We have operated on professional sportsmen (footballers, swimmers etc) who have gone back to training a few weeks after laparoscopic surgery!
Avoid straining and driving for the first few days. Walking is encouraged and a shower is allowed after 48 hours. There may be a slight swelling around the groin but this will go away with time (do not massage it). Good support with a pair of fitting briefs is advisable. We will usually review you a week or two after surgery to assess fitness for resuming work. You can usually go back to exercise after a few weeks but heavy straining (eg lifting weights) should be avoided for a few months.
As with open surgery, bleeding and infection can occur. Contact us immediately if there is severe pain, fever, bleeding or swelling. Nerve injury and hernia recurrence can occasionally occur, but this seems to be lower in incidence compared to open surgery. The risk of this happening in the long term is probably less than 1%.