A GUIDE TO KEYHOLE SURGERY IN HERNIA REPAIR

Nearly 100,000 hernia operations take place in the UK every year. This guide has been written for people who want to find out more about hernias, particularly those having a hernia repaired by keyhole surgery Whilst this guide offers general information about hernia repair operations and keyhole surgery, you should always discuss details of your particular case with your GP or specialist.

Introduction

A hernia is a protrusion of intestine or fat through a weakness in the muscles or lining of the abdomen. This causes a bulge and often leads to pain and discomfort. The weakness often becomes apparent when the muscles are put under a sudden increase in pressure through sport, heavy lifting or coughing. While many hernias are harmless, some, if left untreated, can lead to a blockage or gangrene of the intestine. Both of these complications are emergencies and require surgery. It is important to seek medical advice on any hernia.

There are a number of places in the abdomen where a weakness can occur and lead to a hernia. This guide deals with inguinal (groin) hernias which are the most common and make up 90% of all types of hernia.

Inguinal hernia

Inguinal hernias occur in the groin and are most common in men. The weakness may be present from birth although the potential hernia may not become obvious until later in adult life. They may also occur as a result of weakening of the muscles with age. Many patients describe feeling a tearing sensation in their groin when lifting something heavy. Hernias may occur on either side of the groin.

Surgical procedures for hernia repair

Repairing a hernia is a straightforward operation where the intestine, or other contents of the hernia, are returned to their normal position in the abdomen and the weakness in the abdominal wall is repaired to prevent the hernia recurring. Hernia repair can be carried out by traditional open surgery or by keyhole (laparoscopic) surgery.

In open surgery the surgeon works directly on the repair through a single incision. Recovery from an open hernia repair can take 4 to 8 weeks of convalescence before returning to normal activity.

Keyhole surgery involves one or more small incisions through which special surgical instruments are passed. The surgeon is able to see inside the body using an instrument called a laparoscope. A laparoscope is a form of telescope with a powerful light source. A miniature video camera is connected to the laparoscope and this projects a clear image from inside the body onto a television screen. Viewing the operation on the monitor, the surgeon is able to manipulate the laparoscope and surgical instruments from outside the patient's body to carry out the surgical operation from within.

To create space around the organs and to allow the surgeon a clear view, carbon dioxide gas is introduced into the abdomen. Three tiny incisions are then used for the keyhole (laparoscopic) inguinal hernia surgery through which the surgeon passes the special instruments and equipment needed to repair the weakness. The membrane which lines the inside of the abdomen is peeled back to expose the site of the hernia and a pre-formed mesh is placed across the hernia opening (similar to putting a patch on a burst tyre).

This mesh is designed to be incorporated into the surrounding tissue and is fixed to the abdominal wall, usually with special staples. The mesh and staples will not rust or corrode and remain as a permanent barrier to prevent the hernia from bulging back.

Benefits

The main benefits of keyhole surgery in hernia repair are:

• less pain
• less scarring
• less risk of infection
• short hospital stay
• quicker return to normal activities

Occasionally, during an operation, the surgeon may discover an additional problem which complicates the procedure. In this situation, the surgeon will need to make a number of decisions, which might include converting from keyhole to open surgery. Ask your surgeon to explain the surgical procedure and any possible complications before your operation.