How is Hernia Surgery Performed?
An open or conventional approach to hernia surgery is done through a three to four inch incision in the skin in the groin (just above the inguinal crease). The incision extends through the skin, and though the subcutaneous fat and muscle in order to get to the level of the hernia or hole. The hernia contents are pushed back or reduced back through the hole. Next, a piece of surgical mesh is placed through the hole to repair the defect or hole. An open hernia repair is usually performed with a local anesthetic and intravenous sedation (a twilight) but may be performed with a general anesthetic.
A laparoscopic hernia repair. In this approach, the hernia is repaired through three tiny incisions in your abdominal wall. Through one incision, a small video camera is inserted in order to perform the surgery on a video screen. The surgeon operates through the other two incisions with small instruments. The hernia is repaired from behind the abdominal wall. There is no dividing or cutting of any muscle or structures. This leads to less trauma and inflammation and, thus, a quicker and less painful recovery. A piece of surgical mesh is placed over the hernia defect and held in place with small surgical absorbable clips. This operation needs to be performed via general anesthesia.
A robotic hernia repair. In this approach, the hernia is repaired much like a laparoscopic hernia repair. Three small incisions are used. The surgery is also performed on a video screen. In laparoscopic surgery, the surgeons’ actual hands are grasping and moving the instruments themselves while he or she performs the operation literally right next to the patient. In robotic surgery, the instruments are docked or attached to robotic arms. The surgeon then sits at a console next to the patient’s bed. The surgeon uses small controls at the console to control the robotic instruments.
Why a Laparoscopic Hernia Repair?
A laparosopic hernia repair is a less invasive approach than conventional or open hernia repair. There is no cutting of tissue and no suturing (stitching) of tissue. It is a blunt surgery – meaning no structures are cut or divided. The mesh is not held in by stitches but is anchored by three small dissolvable tacks.
What are the advantages of Laparoscopic Hernia Repair?
Laparoscopic Hernia Repair is a technique to fix a hole or tear in the abdominal wall fascia using small incisions, video cameras and a patch (mesh). The recovery is faster and associated with less pain when compare to open hernia repair. Approximately 14% of patients undergoing open hernia repair can experience long term/chronic groin pain. This is almost non-existent following laparoscopic hernia repair.
A laparoscopic hernia repair offers a quicker return to work and normal activities and decreased pain, both short and long term, when compared to open or conventional hernia surgery.
- Less early post-operative pain
- Less late post-operative pain
- Quicker return to normal activity
- Quicker return to work
- Quicker return to exercise
- More cosmesis
- Ability to correct bilateral (hernias on both sides) hernias through the same three small incisions at the same time
A Clinical Study comparing Laparoscopic versus Open Hernia Repair
Contemporary Surgery – Literature Review
Open Versus Laparoscopic Inguinal Hernia Repair
CHARLES H. COOK, MD, FACS
Assistant Professor of Surgery Department of Surgery The Ohio State University
The debate over the superiority of laparoscopic versus open repair of inguinal hernia continues.
A Prospective Comparison
A prospective study from Sweden suggests that laparoscopic inguinal hernia repair may result in shorter time to full recovery and earlier return to work [Johansen B, Hallerback B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh versus open preperitoneal versus conventional technique for inguinal hernia repair. Ann Surg. 1999;230:225-231].
This randomized prospective study confirms the findings of several other studies in the literature showing a faster return to normal activity as well as faster return to work in patients undergoing laparoscopic inguinal hernia repairs.
Laparoscopic Hernia Repair Video
The above video demonstrates the technique of laparoscopic repair of an inguinal (groin) hernia. Initially, a video camera is inserted in between the layers of the abdominal wall in order to provide visualization of the surgery. Next, two trocars (small tubes where surgical instruments are passed through) are first inserted. These are seen being placed in the beginning of the video. Next the hernia is found and gently peeled of the spermatic cord, vessels which supply blood to the testicle. Once the hernia is reduced or fully brought out of the groin, a piece of mesh is then placed to cover the hole, where the hernia was. The mesh is held in position by two metallic clips, which anchor the mesh to the surrounding tissue. These are seen being placed in the video. At this point, the mesh is held in position and residual gas is removed. The mesh is checked to make sure it stays in the correct position.
Are you a Candidate for Laparoscopic Hernia Repair?
Most patients are excellent candidates for a laparoscopic repair. Only after a thorough examination can it be decided whether a laparoscopic hernia repair is right for you.
If you had a hernia repair via an open procedure and now you have a recurrence, you still can (and should) have a laparoscopic repair to fix the recurrence
The procedure may not be best for some patients who have had previous abdominal surgery or have serious underlying medical conditions.
I had hernia surgery a while ago and now my hernia has returned. Can I now have a laparoscopic repair?
Yes. In fact, a laparoscopic repair is the preferred method if the original hernia surgery was performed in the open or conventional fashion. There is less scar tissue encountered and a better chance of performing a permanent repair.
I have hernias on both sides? Can both hernias be fixed laparoscopically?
Yes, in fact both sides can be fixed at the same time laparoscopically through the same three small holes. This is called a bilateral hernia repair.
What Preparation is required?
- Most hernia operations are performed on an outpatient basis, meaning that you go home on the same day that the operation is performed.
- The surgery generally lasts approximately 1 hour.
- Usually the entire process from checking in to leaving lasts approximately 3 hours
What happens if the operation cannot be performed or completed by the laparoscopic method?
In a very small number of patients the surgery is unable to be completed laparoscopically. Factors that may increase the chances of converting to an “open or conventional” hernia surgery may include obesity, a history of prior abdominal surgery (which may lead to scar tissue), the inability to visualize the hernia, or bleeding encountered during the operation.
The decision to perform the open procedure is a judgment decision made either before or during the actual operation. When it is necessary to convert from a laparoscopic procedure to an open one, this is not truly a complication, but rather sound, smart surgical judgment. The decision to convert to an open procedure is mainly based on patient safety.
Who cannot have a Laparoscopic Repair?
If you have had lower abdominal surgery through a scar in the middle of your abdomen below your belly-button, a laparoscopic hernia repair may not be able to be performed. If you have had surgery through a bikini or Pfannensteil incision, you generally can still have a laparoscopic repair. For patients who take blood thinners, an open or conventional surgery may be a better option.
Open tension-free Hernia Repair
Dr.Lublin does perform the open tension-free repair on some patients (SEE ABOVE).
The tension-free repair is done as follows:
- An incision (cut) is made over the area of the hernia (in the groin) and down through layers of tissue until the hernia is identified.
- The hernia contents are reduced back through the hole into the abdominal cavity
- The hole (or tear) is closed with a plastic-like mesh.
- The overlying tissues and skin are then closed with absorbable sutures
The recovery from a traditional or open repair is longer than a laparoscopic repair. People, still, do quite well following this type of repair.