Laparoscopic Inguinal Hernia Repair

Surgery Overview

nguinal hernia is a bulge that appears in the groin. Surgery is needed to prevent complications including incarceration (a condition in which hernia contents get stuck in the groin) and strangulation (a condition when hernia contents lose blood supply and are at risk of dying). The inguinal hernia repair can be performed using the traditional open method or the new minimally invasive or laparoscopic repair.

Laparoscopic hernia repair is similar to other laparoscopic procedures. General anesthesia is given, and a small incision is made in or just below the navel. The abdomen is inflated with carbon dioxide so the surgeon can see the abdominal organs.

A thin, lighted scope called a laparoscope is inserted through the incision. The instruments to repair the hernia are inserted through another small incision in the lower abdomen. Mesh is then placed over the defect to reinforce the abdominal wall.

What To Expect After Surgery

ost people who have laparoscopic hernia repair surgery are able to go home the same day. Recovery time is about 1 to 2 weeks.

Studies have found people have less pain after laparoscopic hernia repair than after open hernia surgery.

Why It Is Done

ost inguinal hernias are recommended for surgical repair.

Laparoscopic hernia repair is being done as an alternative to open surgery. It may be the preferred option for people who need to return quickly to work or other activities and for those who have hernias on both sides.

Laparoscopic surgery repair may not be appropriate for people who:

• Cannot tolerate general anesthesia
• Have bleeding disorders such as hemophilia or idiopathic thrombocytopenic purpura (ITP)
• Are taking medications to prevent blood clotting (blood thinners or anticoagulants, such as warfarin)
• Have had many abdominal surgeries; scar tissue may make the surgery harder to do through the laparoscope
• Have severe lung diseases such as emphysema; the carbon dioxide used to inflate the abdomen may interfere with their breathing
• Are pregnant
• Are extremely obese

How Well It Works

Laparoscopic surgery has the following advantages over open hernia repair:

• People may prefer laparoscopic hernia repair because it causes less pain and they are able to return to work more quickly than they would after open repair surgery
• Repair of a recurrent hernia after open or laparoscopic surgery often is easier using laparoscopic techniques than open surgery
• It is possible to repair or check for a second hernia on the opposite side at the time of the operation
• Because smaller incisions are used, laparoscopy may be more appealing for cosmetic reasons

Risks

Some people may need special preparation before surgery to decrease the risk of complications. These are people who:

• Have a history of blood clots in large blood vessels (deep vein thrombosis)
• Smoke
• Take blood thinners (such as warfarin, heparin, and enoxaparin)
• Take large doses of aspirin. Aspirin slows blood clotting and may increase the chances of bleeding after surgery
• Have severe urinary problems, such as those caused by an enlarged prostate gland

In addition to risks typically associated with any laparoscopic surgery, risks of laparoscopic inguinal hernia repair include:

• Pain in the cord carrying sperm from the testicle to the penis (spermatic cord), in the testicles, or in the thighs
• Fluid (seromas) or blood (hematomas) in the scrotum, the inguinal canal, or the abdominal muscles
• Inability to urinate (urinary retention) or bladder injury
• Infection from the mesh or stitches
• Scar tissue formation (adhesions)
• Injury to abdominal organs, blood vessels, and nerves
• Numbness in the thigh
• Pain in the thigh (nerve entrapment)
• Injury to the testicle, causing testicular atrophy (rare)
• Recurrence of the hernia (usually related to the mesh applied during surgery being too small to cover the groin area or the mesh not being stapled well). In studies, recurrence rates vary widely; experts suggest that the experience of the surgical team plays an important role in recurrence rates because laparoscopic techniques can be difficult to master. Some studies have shown that up to 6% of hernias repaired with laparoscopic surgery may recur. Large, multicenter studies have found recurrence rates as low as 0.4% to 2%; one study of 1,700 people reported a rate of 0.29% about 5 years after surgery, but this figure reflects the work of one surgical team rather than the many teams in multicenter studies

Laparoscopic inguinal hernia repair is different from open surgery in the following ways:

• A laparoscopic repair requires several small incisions instead of a single larger cut
• If hernias are on both sides, both hernias can be repaired at the same time without the need for a second large incision. Laparoscopic surgery allows the surgeon to examine both groin areas and all sites of hernias for defects. In addition, the patch or mesh can be placed over all possible areas of weakness, helping prevent a hernia from recurring in the same spot or developing in a different spot
• A person must receive general anesthesia for laparoscopic repair, whereas open hernia repair can be done under general, spinal, or local anesthesia

When To Call Our Office?

f you develop any of the following, be sure to call our office at (814) 877-6997 during business hours (9am-5pm Monday-Friday)

• Persistent fever (over 100°F)
• Bleeding
• Increased groin swelling or pain
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Drainage from any incision
• Redness surrounding your incisions

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