Hernia Surgery

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Groin Hernia Surgery

The most appropriate type of groin (inguinal) hernia repair depends on a number of factors:

  • The type of hernia
  • If you have had previous surgery
  • If you have 2 hernias, one on each side of the body (bilateral)
  • Your age, lifestyle and general state of health.

Open hernia surgery is usually performed under a general anaesthetic, which means you will be asleep throughout the procedure. A local anaesthetic (meaning you will be awake but the area being operated on will be numb) may be recommended if you have higher risks associated with a general anaesthetic.

A tension free mesh repair is the gold standard for repair of single (unilateral) primary groin hernias. The inguinal hernia is repaired by making a 6 to 8cm incision in the groin skin crease, the external layers of the abdominal wall are opened, the inguinal hernia sac is identified and carefully dissected away from sensory nerves, the blood vessels and spermatic cord that pass down to the testicle. The sac is then usually tied off and a synthetic mesh is overlaid to strengthen the abdominal wall and prevent recurrence of the hernia. The abdominal wall is closed in layers including the skin with dissolvable sutures. Skin glue is usually used over this to seal the area.

The technique takes about 60 minutes to perform, you will usually be able to go home 2 to 3 hours after the operation, when you have passed urine and are mobilising safely.

A telescope is placed into the abdomen cavity (next to the bowel inside the peritoneal sac) via a small umbilical incision and the hernia sac is identified from the inside (Keyhole Surgery).

3 more 5mm instruments are inserted into the abdominal cavity; the hernia sac is pulled back and inverted. The peritoneum (the sac that contains the bowel) is then incised and a large 15 x 15 cm mesh is placed between the muscle wall and the peritoneum to cover the hernia hole. The peritoneum is then secured back into place with a number of corkscrew like tacks.

Transabdominal Pre-Peritoneal Repair (TAPP)

Laparascopic or keyhole surgery is less invasive than conventional open surgery, has a shorter recovery time and less pain. The procedure is technically more difficult and is recommended for recurrent or bilateral hernias. The risk of the hernia returning is the same for laparascopic repair as it is for open repair. There is a higher theoretical risk of accidental damage to the structures inside your abdomen.

Laparoscopic repair is carried out under general anaesthetic so you will be asleep throughout the procedure. Three small incisions are made in the abdominal wall rather than one larger one.

There are two main types of laparoscopic surgery for hernias, we offer both:

  • Transabdominal pre-peritoneal (TAPP)– this involves instruments being inserted into your abdominal cavity (peritoneal sac) next to the bowel
  • Totally extraperitonel (TEP)– this repairs the hernia without going into the abdominal cavity (peritoneal sac).
Totally Extra peritoneal Repair (TEP)

This is a minimal access (keyhole) technique. A small incision is made below the umbilicus and a camera is passed into a space behind the abdominal muscles but in front of the peritoneum.

Two more 5mm instruments are passed through the midline of the abdomen. The hernia sac is identified and pulled back. A large specially shaped 15 x 12 cm mesh is placed over the hernia hole.

The advantage of the technique is that the peritoneum is not entered, making bowel damage slightly less likely than the TAPP operation and only one corkscrew like tack is used in the midline away from any nerves. This is a technically more difficult procedure than the TAPP repair but in experienced hands this is a reliable technique with potentially less short and long term pain.

  • You will walk out of hospital usually 2 to 3 hours after surgery. We will check your blood pressure, you have passed urine and are safe when you start mobilising
  • You should take regular pain killers for at least 2 days, usually paracetamol and ibuprofen (unless you have a specific allergy and not ibuprofen if you have asthma, reduced kidney function or stomach ulcers). The local anaesthetic will numb the area for a few hours (can occasionally cause some upper leg numbness and weakness)
  • If skin glue has been used you can remove any remaining dressings and shower from the day after surgery (you only need more dressings if your clothing is rubbing on the incision)
  • You should not drive until you can do a safe emergency stop, usually 2 weeks (you should check with your car insurer)
  • You should avoid heavy lifting for 6 weeks after surgery (more than about 3 kg) to allow the mesh time to ‘bed in’.

It is important you are aware of any potential complications from the surgery even if they are rare. As part of a fully informed consent process we will discuss all of them, general risks and those specific to the procedure:

  • Bleeding
  • Damage to the cord structures passing down to the testicle, the spermatic cord and vessels to the testicle. If the blood supply is damaged this can cause pain and shrinkage of the testicle (ischaemic orchitis) and even loss of the testicle
  • Damage to intra-abdominal structures (bowel, bladder and blood vessels)
  • Scrotal swelling and bruising
  • Numbness to skin around the incision
  • Infection of soft tissues and rarely infection of the mesh. Mesh infection is significant as it cannot be irradiated by antibiotics, the mesh needs to be removed
  • Chronic nerve pain, which can occur in up to 15% of cases (lower in TEP laparoscopic repair) and is caused by scarring around sensory nerves and can be related to the mesh
  • Recurrence of the hernia.

Laparoscopic repairs access the hernia in the same plane behind the abdominal wall muscles that is potentially used for laparoscopic or robotic prostate surgery and so can result in such an approach being more difficult or not achievable in the future.

Find out about the consultants that will be looking after you, and their expertise in bowel and hernia diagnosis and treatment

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