Laparoscopic Inguinal Hernia Repair (Extraperitoneal)

Pre-operative Preparation for a Laparoscopic Inguinal Hernia Repair (Extraperitoneal) procedure

There is some important information about the pre-operative preparation for this procedure. It is imperative that you read this.

Read about Hernia Pre-operative Preparation

Procedure

The laparoscopic approach (key hole) is now the approach that is preferred by the majority of surgeons and patients, as opposed to the more traditional open hernia repair. Strictly speaking it is not laparoscopic i.e. there is no requirement to go into the abdominal cavity proper. A potential space is established between the muscles of the anterior abdominal wall and the peritoneum (lining of the abdominal cavity). This allows identification of both a direct defect and an indirect sac and more importantly the mesh which is an essential part of the repair is placed within this potential space, thereby obviating any contact of the mesh with the bowel and therefore the attendant risk potentially of adhesions which might otherwise lead to a bowel obstruction. The distinction between a direct inguinal hernia which is a protrusion through the muscle of the groin and an indirect hernia which is a persistence of a congenital (i.e. you are born with it) peritoneal sac that extends into the inguinal canal is a technical one. For all intents and purposes the repair is very similar and for practical purposes the recovery is identical.

The operation is performed under general anaesthesia. A 10mm incision is made just below the umbilicus (belly button). Two further 5mm incisions are made out towards the hip bones. The potential space between the muscles of the anterior abdominal wall and the peritoneum is developed using special instruments. The hernia if it is direct is reduced and if indirect the peritoneal sac is separated from the spermatic chord in males or the round ligament in females. Mesh is then placed to cover this area on the inside and secured with multiple fine titanium tacks. Both the mesh and the tacks stay in place forever. As they are both inert they are not subject to any potential form of rejection by the body. The three wounds are closed with sutures that go underneath the skin (and therefore do not need to be removed) and then injected with long acting local anaesthetic. Finally a dressing is placed over the three wounds.

The patient is transferred to the recovery room and then either to the day surgery unit if the operation is being performed as a day case or back to the ward if staying overnight.