Laparoscopic Hernia Repair

Gordon Buchanan Gordon Buchanan Consultant Colorectal, Laparoscopic and General Consultant Colorectal, Laparoscopic and General

SurgeonSurgeon

Background

• Colorectal Surgery – Lap and Open

• General and Emergency Surgery– Lap Appendicectomy– Lap Cholecystectomy– Hernia – why not lap?

What is possible ?

• Laparoscopic Inguinal Hernia• Laparoscopic Femoral Hernia• Laparoscopic Umbilical Hernia• Laparoscopic Ventral Hernia• Laparoscopic Incisional Hernia

Advantages

• Less Pain• Smaller scars• Lower Wound infection• Faster Return to activity• Several hernias fixed through same

incisions

Cautions• Relative

– Complex abdominal surgery– Previous preperitoneal surgery– Irreducible hernia (especially left side)

• Absolute

– Inability to tolerate general anesthesia.

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE - 2004

Laparoscopic surgery for inguinal hernia repair

1.1 Laparoscopic surgery is recommended as one of the treatment options for the repair of inguinal hernia.

1.2 To enable patients to choose between open laparoscopic - transabdominal preperitoneal [TAPP]

- totally extraperitoneal [TEP],

fully informed of all risks and benefits associated with each of the three procedures.

TEP Developing a

plane

Increase Laparoscopic Inguinal Hernia Repair

Risks

Risks of any operation (anaesthetic, DVT etc)

Risks specific to inguinal hernia repair:

Immediate:Bleeding at the time of surgery Damage to the testicular vessels or other structures (rare)

Early:Haematoma in wound or scrotum Infection of the wound (<5%), Retention of urine.

• Late: – Recurrence: <5% life time risk.– Damage to nerves– Normal to expect some numbness below scar

as cutaneous nerves are divided gaining access to the inguinal canal.

– Ongoing groin pain 3-5% - damage or entrapment of ilioinguinal nerve

Post op

• Daycase / 1 night• No restrictions• Driving 24hrs• Exercise – as comfort allows• Return to work 4 days• Heavy lifting as they wish• Sex – Encouraged

Incisional Hernia

• Laparoscopy– New meshes against bowel– Smaller scars– Less wound infection– Size of defect

Summary

• Laparoscopic Repair

– Most types hernia– Quicker recovery– Caution in complex abdomen– Less pain