Laparoscopic Hernia

Weak spots can develop in the layer of muscle in the abdominal wall, resulting in the contents of the abdomen pushing through. This produces a lump called a hernia. A swelling becomes apparent on the abdominal wall, most commonly in the groin region, where it is known as an inguinal hernia. A hernia develops because of a weakness in the abdominal wall that allows the protuberance of fat and/or bowel which is contained in a sac of the inner lining of the abdominal cavity (peritoneum). The weakness might have been present for many years or might have developed with age or after failure of a surgical wound (incisional hernia). The risks are that small bowel can enter the sac and become trapped, causing bowel obstruction and/or perforation.

Certain factors such as chronic constipation, chronic coughing, obesity, and an enlarged prostate may increase the risk of developing a hernia.

Dr Ankur Bansal is senior consultant at S.R Multisuperspeciality Hospital expert in all types of Hernia repair & management provides comprehensive care to all his patients.

Common types of Hernia

• Inguinal hernia:This is a common type of hernia, especially in men. It often develops as a result of strenuous activity and becomes uncomfortable and is often associated with a bulge or lump in the groin area. Sometimes the hernia can be come very large and descend into the scrotum. The treatment for inguinal hernia is surgery. A truss, advocated by some, is not advised. Surgery can be performed from the front (open hernia repair) or with more extensive dissection from behind using laparoscopic methods (laparoscopic hernia repair). Both are effective, and both use mesh. Despite what enthusiasts for laparoscopic hernia repair wills say, the evidence shows that there is very little difference between the two approaches. The alternatives will be discussed.
• Epigastric hernia:There is a natural line of weakness in the upper midline of the abdomen and this is where epigastric hernias develop. The principles of surgical repair are similar.
• Umbilical and para-umbilical hernias:Another area of weakness is in and around the umbilicus (tummy button). The principles of repair are similar.
• Incisional hernia:Incisional hernia occurs because of the failure of the scar from a previous previous surgical incision made in the abdomen. They are more common after infection of the previous incision and in obese or pregnant patients. Incisional hernias can be very small or large and there are several repair options that will be discussed.
• Femoral Hernia:Femoral hernias more commonly develop in women and older patients. The defect is below the inguinal region.

Virtually all hernias need to be surgically repaired. The principle is the same for all hernias. The peritoneal sac needs to be identified and separated from surrounding tissue, opened and the contents reduced back into the abdomen, tied off and the sac removed, and then repair of the weakness in the abdominal wall. This repair can be done by just closing the edges together with strong stitches or by using an artificial mesh to bridge the defect. The mesh can be laid inside the defect or on the outside. Both traditional open and laparoscopic approaches are widely used. The operation is finished by closing the fat and skin layers.

Surgical repair of Hernias

• Open hernia repair: Under general anaesthetic a skin crease incision is made in the groin overlying the lump. The hernia is identified and dealt with by isolating the peritoneal sac, reducing its contents, closing and excising the redundant sac and then gently laying a reinforcing mesh over the weakened area. The muscle, fat and skin are closed over this.
• Laparoscopic hernia repair: The laparoscopic technique of hernia repair avoids the large skin and muscle cut of open approaches, as well as closure of the defect with sutures under some tension. This way post-operative pain is decreased, and earlier return to discomfort-free work is possible. The laparoscopic approach to inguinal hernia repair involves three small incisions and an extensive dissection of the abdominal wall behind the hernia and a more difficult dissection of the sac. A much larger mesh is used and fixed with a series of tacks.