Laparoscopic Hernia Repair

What is a hernia?

A hernia is caused by a weakening or tear of the abdominal wall. The inner lining of the abdomen, fat or internal organs can push through this weakened area and cause a sack to form. At this point, you may not be able to see the bulge but may feel burning or tingling. As abdominal contents begin pushing into the sack, a bulge may be noticeable.

What are the various types of hernia?

Hernias can occur in any weak or torn part of the abdominal wall.

An incisional hernia usually protrudes through the scars of previous surgical incisions and can develop months to years after the initial surgery.

The most common hernias occur in the groin area. An indirect inguinal hernia descends from the abdomen and can extend all the way into the scrotum. A direct inguinal hernia occurs less frequently and is usually caused by an acquired weakness in the groin. A femoral hernia is more common in women and is the result of an acquired weakness in the lower groin area.

How are hernias treated?

When a hernia is diagnosed, surgical repair is usually recommended because it will not go away by itself and serious complications can develop.

How is laparoscopic hernia repair performed?

Laparoscopic hernia repair is performed with the patient under general anesthesia. A small, one-half inch incision is made near the navel and the abdominal wall is elevated by inflating the abdomen with carbon dioxide gas. A small metal tube is placed through this incision into the abdomen, which allows the laparoscope (a thin, lighted tube used to look at tissues and organs inside the abdomen) to be introduced to identify the hernia. Two more cannulas (hollow sheaths) are then introduced in the right and left sides of the abdomen. The surgeon uses these cannulas to introduce the patch and various instruments to perform the surgery.

Once the defect is identified, the inner lining of the abdomen is prepared to provide a covering for the mesh that will be used to repair this weakened area from the inside. The defect is measured, and an appropriate piece of mesh is introduced and stapled into place.

When is laparoscopic hernia repair the treatment of choice?

Traditional open surgical repair is usually the operation of choice for inguinal hernias located on one side that have not previously been repaired. The laparoscopic approach is most often used for patients who have recurrent hernias or hernias on both sides of the groin. The appropriate method is determined after your examination in consultation with your surgeon.

What are the advantages of laparoscopic hernia repair?

As with other minimally invasive procedures, patients who undergo laparoscopic hernia repair usually have fewer complications, a shorter hospital stay, less pain and a much faster recovery than with traditional open surgery.

The patient is usually discharged the same day or the next morning with activities limited for two weeks.

What are the risks?

There are some risks associated with laparoscopic hernia repair. These include possible adhesions developing between the organs in the abdomen and the plastic patch, infection of the patch and damage to the intestines, the spermatic cord in men or nerves and blood vessels, which feed the testicle and leg. Many of these same complications, except for internal damage or adhesions, can also occur with open hernia repair.

Washington University in St. Louis surgeons who perform this procedure:

Michael M. Awad, MD
L. Michael Brunt, MD
J. Christopher Eagon, MD