Laparoscopic Hernia Inguinal (groin) Repair

Approximately 600,000 hernia repair operations are performed annually in the United States. Traditional open hernia repair surgery requires a 3-5 inch long incision, 2 to 3 weeks of painful recuperation and slight increased possibility of infection.

The laparoscopic technique makes it possible to perform this procedure in a minimally invasive manner and even repairing right and left side hernia repairs through the same small incisions. The patient goes home with only 3 or 4 tiny incisions, experiences minimal discomfort and, in many cases can return to normal activity in as little as two days. Dr. Vazquez uses the TEP (Totally Extra Peritoneal) laparoscopic hernia repair technique. Some patients are not proper candidates for a laparoscopic hernia repair and Dr. Vazquez performs open hernia repair for those patients

What is a hernia?

A hernia occurs when the inside layers of the abdominal wall weaken and then bulge or tear. In the same way an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing severe pain and other potentially serious health problems.

How do you get a hernia?

Hernias usually occur because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall. In males, a natural weakness is created prior to birth when the testis (testicle) and spermatic cord descend through the inguinal canal from the abdominal cavity into the scrotum. In females, a ligament makes the same descent through the canal.

Is there more than one kind of hernia?

Although any part of the abdominal wall can rupture, approximately 80% of all hernias are located near the groin. When a hernia near the groin occurs next to an existing structure, such as the spermatic cord, it is called an indirect inguinal hernia. When a hernia near the groin results from protrusion of viscera through the floor of the groin canal, it is called a direct inguinal hernia. Hernias may also be found below the groin (femoral), through the navel (umbilical), and along a previous incision (incisional).

Can anyone get a hernia?

A hernia can occur in anyone at any age. In children, an excessive natural weakness can lead to a hernia.
In adults, a natural weakness or strain from heavy lifting, substantial weight gain, persistent coughing or
difficulty with bowel movements or urination can cause the abdominal wall to tear.

How is traditional hernia repair performed?

The 3- to 5-inch incision is made on an angle just above the line where the abdomen meets the thigh is made through several layers of skin, fatty tissue and muscle to reveal the location of the hernia.

The most important part of the surgical repair involves closure of the abdominal opening(s) in the inguinal canal. This closure is accomplished by sewing the edges of the remaining tissue together or more commonly by attaching a mesh patch to the abdominal wall.

How is laparoscopic hernia repair performed?

Laparoscopic hernia repair usually takes place under general anesthesia, so the patient is asleep throughout the procedure. Using a trocar (a narrow tube-like instrument), the surgeon gains access just below the navel. A laparoscope (a tiny telescope) connected to a camera is inserted through the trocar, giving the surgeon a magnified view of the patient’s hernia on a video monitor.

Two or three additional trocars are inserted to accommodate special instrumentation. The surgeon pulls the hernial sac back and exposes the defect in the abdominal wall. The defect is covered with a mesh patch that is anchored to the abdominal wall and pubic bone with an instrument called a spiral tacker.

Following the repair, the small incisions are closed with a stitch or two or surgical tape. Within a few months, the incisions are barely visible. TOP

What are the advantages of laparoscopic hernia repair?

Laparoscopic hernia repair requires only 3 or 4 tiny openings, each 1/4 to 1/2 inch in diameter, instead of the traditional 3- to 5-inch incision. As a result, patients experience much less postoperative pain, heal faster, and many are able to resume normal activities in as little as two days compared to 3 to 5 weeks.

In addition, with laparoscopic hernia repair, the mesh patch used to cover the abdominal defect is placed on the inside of the abdominal wall instead of the outside. This method works with the natural outward pressure of the abdomen to secure the repair and promote healing.

How soon will I go home?

Both traditional and laparoscopic hernia repair are usually performed on an outpatient basis. Patients are generally permitted to return home within 4 to 6 hours following the procedure.

Is laparoscopic hernia repair a new procedure?

Dr. Vazquez has been performing laparoscopic hernia repairs for the past 15 years. Not all general surgeons are comfortable performing laparoscopic hernia operations. Ask your surgeon if they perform hernia repairs using the laparoscopic technique. Today, more than 90% of all gallbladder surgery is performed laparoscopically. More recently, general and thoracic surgeons have applied the laparoscopic technique to a broad range of surgical procedures including appendectomy, hysterectomy and lung and bowel surgery.

It is important to remember that before undergoing any type of surgery, whether laparoscopic or traditional, you should ask your surgeon about his or her training and experience.

Am I a candidate for laparoscopic hernia repair?

If you have an inguinal or femoral hernia, you may be a candidate for laparoscopic hernia repair. Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have some pre-existing medical conditions. A thorough evaluation by a qualified surgeon can determine if laparoscopic hernia repair is an appropriate procedure for you.

Click on this link to view a laparoscopic TEP hernia repair performed by Dr. Vazquez using PolyPro® Hydrocoat

Content reviewed and updated on September 26, 2014.