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Laparoscopic Mesh Repair of Inguinal Hernia

A hernia occurs when the internal organs of the abdominal cavity push through a weakened spot in the abdominal wall to form a bulge.

Hernias may be repaired surgically by closing the defect and using mesh to strengthen the weakened area. This can be performed in a minimally invasive manner using a laparoscope.

Disease Overview

An inguinal hernia is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin. Inguinal hernias commonly occur in men as they follow the path of the blood vessels to the testicular.  Consequently, if a hernia becomes large the contents may pass into the scrotum.

Hernias may not cause any symptoms, but may be discovered on a routine medical exam or test.  Symptoms can include pain, aching, discomfort, or a heaviness in the groin. The bulge formed is more prominent when you stand, cough or strain, and may disappear while lying down as it slips back into the abdomen.

A hernia can sometimes become trapped or strangulated and cannot be pushed back into the abdomen.  This is referred to as an irreducible hernia. It is a dangerous situation when the blood supply to the hernia can be compromised and may require emergency surgery.

Indications

Small hernias that do not cause any symptoms are usually treated by a wait-and-watch approach. If enlarging or developing symptoms they may need surgery.

Surgery is recommended for hernias that show symptoms, are enlarged or entrapped. Surgery may involve an open hernia repair with a traditional incision or laparoscopic surgery, a minimally invasive approach with smaller incisions.

Laparoscopy is especially advised for patients with recurring hernias (previous open repair), bilateral inguinal hernias and some femoral hernias. However, it is not recommended for patients with very large hernias, strangulated hernias, prior pelvic surgery and intolerance to general anaesthesia. These would typically require an open approach.

Surgical Procedure

Laparoscopic hernia repair is performed under general anaesthesia. Your surgeon will make a few small incisions in your abdomen or groin through which a thin tube called a laparoscope and other special instruments are inserted. A video camera attached to the laparoscope sends magnified images to a monitor guiding your surgeon throughout the procedure. Your surgeon will push the bulge back into the abdomen and either apply a specially designed soft plastic mesh to support the weakened wall.

Post-Operative Care

Laparoscopic repair of inguinal hernia is usually performed as a day or overnight procedure so you will return home after a few hours of observation. You may have some swelling or bruising at the incision sites, the groin or scrotum, which is normal.  Pain and swelling are mostly controlled with medications. It is important to avoid strenuous activity or heavy lifting for at least 6 weeks after the procedure.

Advantages & Disadvantages

Laparoscopic hernia repair is a minimally invasive procedure and as such is associated with less tissue damage and pain and a faster recovery compared to the open approach.  This surgical approach allows you to return home the same day and get back to your regular activities sooner.

Risks & Complications

As with any surgery, complications may occur. Complications related to laparoscopic hernia repair include:

  • Chronic groin pain (less common with laparoscopic repair)
  • Infection at the incision site or on the mesh
  • Bruising or fluid accumulation at the wound site
  • Urinary retention (inability to pass urine after the operation)
  • Hernia recurrence (in around 2% of cases)