INGUINAL HERNIA PROCEDURE

Laparoscopic Groin Hernia Repair

 “More than 600,000 hernias are diagnosed annually in the United States. It is estimated that 5% of the population will develop an abdominal wall hernia. About 75% of all hernias occur in the inguinal region”

INTRODUCTION

All groin hernia types (inguinal and femoral) are repaired using the same principles. In the past, sutured tissue repairs approximating them to close the defect were popular, but now, it is more of historical interest, this technique is being widely abandoned in the present, because of the high recurrence rates and intense postoperative pain.

The best option out there is the “tension-free” repair (open or laparoscopic), using prosthetic material (a mesh) to widely overlap all of the potential sites of herniation, without trying to close the defect with the weakened patient’s own tissues, thus, leading to less recurrence and much less pain; adding this concept to the laparoscopic approach, has made the groin hernia repair to evolve enormously in the last 15 years.

SIGNS AND SYMPTOMS
DIAGNOSIS & TREATMENT
INDICATIONS & CONTRAINDICATIONS
LAPAROSCOPIC VS OPEN HERNIA REPAIR
SURGICAL TECHNIQUE (SIMPLIFIED EXPLANATION)
FEMORAL HERNIAS

SIGNS AND SYMPTOMS

  • Bulge in the inguinal region remains the main diagnostic finding in most of the cases, this bulge can enlarge upon increases in the intraabdominal pressure or the standing position.
  • Pain or vague discomfort in the region; groin hernias are usually not extremely painful unless incarceration or strangulation has occurred.

DIAGNOSIS

It is done by a physical examination. Just in difficult cases, imaging studies such as ultrasound or CT Scan, may have a role. Occasionally, laparoscopy can be both diagnostic and therapeutic for particularly challenging cases.

TREATMENT

As mentioned earlier, a hernia can be repaired with the approximation of the patient’s own tissues or using a prosthetic material to close the defect, the first has been widely abandoned (it is reserved for specific cases) and the second technique, “tension-free” repair is now the standard. The tension free repair can be made through the traditional approach, “open or anterior” or the “laparoscopic approach”; it is Dr. Rosales’ preference to use this last approach in the majority of his patients, taking in consideration the great advantages laparoscopy offers.

INDICATIONS FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

  • Direct and Indirect inguinal hernias
  • Femoral hernias
  • Bilateral hernias
  • Recurrent hernias

CONTRAINDICATIONS

  • Incapability to use general anesthesia
  • Incapability of “reduction” of the hernia contents before surgery or after induction of anesthesia.
  • Elevated bleeding risk

COMPLICATIONS

  • Bleeding <1%
  • Hematoma 5%
  • Visceral injury <1%
  • Wound infection 2%
  • Bowel obstruction <0.5%
  • Urinary retention 2%
  • Nausea and vomiting 8%
  • Recurrence 1 – 3%
  • Inguinodynia (chronic pain in the groin)1%

**These complications are low in frequency in experienced hands, some of them are, and to any other laparoscopic procedure, so this is even lower if the surgeon has training in advanced laparoscopic procedures. It should, moreover, be remembered that many of these complications are transient and can be addressed easily.

LAPAROSCOPIC VS OPEN HERNIA REPAIR

“Example of the forces exerted from the inside of a tire; the same happens with the abdominal wall, so the laparoscopic placement of the mesh (meaning, fixated from the inside) takes advantage of the abdominal wall’s natural forces to keep the defect completely covered and the mesh in place.”

Advantages of laparoscopic hernia repair versus open repair

 

  • Very small incisions (3)
  • The possibility of using the abdominal wall’s natural forces to anchor the mesh in place.
  • Better visualization of the anatomy of both groin regions, since the possibility of bilateral defects exists.
  • Fast recovery time (one night hospital stay)
  • Minimal postoperative pain
  • Lower morbidity rate
  • Lower hospital stay
  • Return to normal activity and return to work in shorter period of time (complete recovery in 5 to 7 days)
  • Decreased risk of wound infection and hernia formation
  • Minimal scarring

 

 

SURGICAL TECHNIQUE

Under general anesthesia, a 10 mm incision is made at the navel (umbilicus), CO2 is introduced to the cavity, then 2 more incisions are made in the abdomen (both of 5mm) to introduce the rest of the instruments, the hernia defect is detected, the hernia sac and its contents are brought back to the abdominal cavity, the whole area is disected and the mesh is introduced thorugh one of the incisions and placed in the groin region, then it is fixed with staples, incisions are closed with suture and the procedure is completed.

 

**The materials Dr. Rosales use depend on what is best for your case and his personal preference.

 

Incisions for Laparoscopic Inguinal Hernia Repair

FEMORAL HERNIAS

Since this type of hernia is also considered a groin hernia, and since it is diagnosed and treated with exactly the same techniques than the inguinal hernias no need exists to highlight details of it.

So if you have been diagnosed with a femoral hernia, please click here.

 

If FAQs and Specific FAQs have not answered yet all your questions or concerns, please click here

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