Laparoscopic Groin Hernia Repair

What is a laparoscopic groin hernia repair?

A hernia is due to a weakness in the abdominal wall resulting in intra-abdominal contents – such as fatty tissue or bowel - protruding through and forming a lump.  In the groin, this is commonly due to a weakness in the inguinal or femoral region. The surgery involves reducing the contents of the hernia and reinforcing the area with mesh using a keyhole approach.

Why should I have a laparoscopic groin hernia repair?

Surgery is the only way to fix a hernia.  Initially, the hernia may not be very symptomatic causing a bulge in the groin area, with time this can enlarge and cause more discomfort.  The contents of the hernia may become obstructed or have impaired blood supply resulting in a surgical emergency.  An elective operation to fix the hernia removes this risk.

How is the surgery performed?

You will have a general anaesthetic. An incision below the naval allows a laparoscope to be inserted, this is a small camera allowing visualisation of the hernia. Two 5mm incisions are made in the midline for surgical instruments.  The hernia sac and its contents are returned to the abdomen where they belong.  Space is created to allow placement of mesh behind the muscle layer, this is to reinforce the area and prevent a recurrence. If you have a hernia on both sides, these are repaired through the same keyhole incisions. Your skin is closed with dissolvable sutures. Waterproof dressings are placed.

What are the risks of laparoscopic groin hernia repair?

Bleeding. Infection.  Recurrence of hernia<5%.  Injury to intra-abdominal organs (rare).  Chronic pain <5%.  Conversion to open repair.

Before the operation

You will be admitted on the day of surgery. You cannot eat or drink for at least 6 hours before the operation. If required, the lower part of your abdomen will be shaved.

After the operation

You will be able to drink fluids in the recovery area, and if this is well tolerated you will be able to start solid food. You will be given pain relief regularly and should continue to use this once you have been discharged home. You will be encouraged to mobilise early as this aids recovery and can prevent some complications such as clots forming in your legs. Depending on the time of your operation and your personal circumstances you will either be admitted overnight or may be able to go home the day of your operation. You will need someone to drive you home. You should not do any heavy lifting for 4 weeks after surgery to allow the naval wound to heal fully and decrease the chance of a hernia developing or recurring. You will be followed up in the rooms 4 weeks postoperatively.

NZAGS Position Statement on Mesh

There has been much controversy in the media recently regarding transvaginal mesh prolapse repair and its potential associated risks of infection, erosion and chronic pain. Unfortunately, the media have portrayed the outcomes of this one gynaecological procedure to include all surgical use of mesh for hernia repair. It has caused unnecessary widespread patient stress and anxiety throughout New Zealand. The use of mesh in General Surgery to repair hernias of the groin or the abdominal wall is well established internationally and is considered the procedure of choice.

For ventral hernias with fascial defects greater than 2cm in diameter, mesh must be used to reinforce the tissue repair. If not, the hernia recurrence rate without mesh is unacceptably high. For groin hernia repair most surgeons worldwide use mesh for the repair. The use of mesh for abdominal and groin hernia repair is safe. Chronic pain may occur after hernia repair in less than 10% of patients. However, it is important to remember that chronic pain after groin hernia repair is higher for patients having non-mesh repair compared to mesh repair.  Mesh infection after abdominal hernia repair is uncommon, less than 1 %. For laparoscopic inguinal hernia repair it is even lower. The use of surgical mesh is an important part of the curriculum for general surgical training and NZ general surgeons have extensive experience in the use of mesh for hernia repair. The good results of mesh hernia repair in general surgery should not be bought into disrepute by categorising all mesh repairs as the same.

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