Laparoscopic Inguinal Hernia Repair
Surgery Overview
Laparoscopic hernia repair is similar to
other laparoscopic procedures. General anesthesia is given, and a small cut
(incision) is made in or just below the navel. The abdomen is inflated with air
so that 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 other small incisions in the lower
abdomen. Mesh is then placed over the defect to reinforce the abdominal wall.
There are many things to consider when deciding if you should
have
inguinal hernia repair surgery, such as whether your
hernia is
incarcerated or
strangulated and whether you have other conditions
that need to be addressed before hernia repair surgery is appropriate.
What To Expect After Surgery
Most people who have laparoscopic
hernia repair surgery are able to go home the same day. Recovery time is about
1 to 2 weeks.
You
most likely can return to light activity after 1 to 2 weeks. Strenuous exercise should wait until after 4 weeks of
recovery.
Studies have found that people have less pain after
laparoscopic hernia repair than after open hernia surgery.1
Why It Is Done
Surgical repair is recommended for
inguinal hernias that are causing pain or other
symptoms and for hernias that are incarcerated or strangulated. Surgery is
always recommended for inguinal hernias in children.
Laparoscopic
surgery repair may not be appropriate for people who:
- Have an incarcerated hernia.
- Cannot
tolerate general anesthesia.
- Have bleeding disorders such as
hemophilia or
idiopathic thrombocytopenic purpura (ITP).
- Are taking medicines 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.
Laparoscopic hernia repair usually is not done on children.
But a laparoscope may be used during open hernia repairs in children to explore
the opposite groin for a hernia. This can be done by inserting the laparoscope
into the side that is being operated on and looking at the opposite side. If a
hernia is present, the surgeon can repair both sides during the same
operation.
How Well It Works
The chance of a hernia coming back
after laparoscopic surgery ranges from 1 to 10 out of 100 surgeries
done.2
Laparoscopic surgery has the
following advantages over open hernia repair:
- Some 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.1
- Repair of a recurrent hernia often is easier using laparoscopic
techniques than using open surgery.
- It is possible to check for and
repair 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 large doses of aspirin. Aspirin slows blood clotting and may
increase the chances of bleeding after surgery.
- Take blood thinners
(such as warfarin).
- Have severe urinary
problems, such as those caused by an enlarged
prostate gland.
Risks of laparoscopic hernia repair include:
- Risks of general anesthesia.
- Pain in the testicles or in the cord that carries sperm from the
testicle to the penis (spermatic cord).
- Damage to the cord that carries sperm from the testicles
to the penis. This could affect your ability to father
children.
- 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 or pain in the thigh.
- 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).
What To Think About
Laparoscopic 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. Also, 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.
- General anesthesia is needed for laparoscopic repair. Open hernia repair can be done under general, spinal,
or local anesthesia.
Laparoscopic repair of a hernia is more expensive
than open surgery because of the increased costs associated with slightly
longer operating-room time and the cost of laparoscopic technology.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- McCormack K, et al. (2003). Laparoscopic techniques
versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews (1).
- Neumayer L, et al. (2004). Open mesh versus
laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine, 350(18): 1819–1827.
Other Works Consulted
- Society for Surgery of the Alimentary Tract (2006). SSAT patient care guidelines: Surgical repair of groin hernias. Available online: http://www.ssat.com/cgi-bin/hernia6.cgi.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | C. Dale Mercer, MD, FRCSC, FACS - General Surgery |
|---|
| Last Revised | April 26, 2011 |
|---|
Last Revised:
April 26, 2011
McCormack K, et al. (2003). Laparoscopic techniques
versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews (1).
Neumayer L, et al. (2004). Open mesh versus
laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine, 350(18): 1819–1827.
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