Hernias occur due to a weakness or tear in the surrounding structure of an organ or body tissue. This defect allows organs and tissue to bulge, or herniate, into another area of the body. There are several different types of hernias but the surgical treatment of them all relies on the same principle of restoring everything in its proper place and repairing the hole. The aim of hernia surgery is to prevent life-threatening bowel strangulation and therefore avoid emergency surgery.
Laparoscopic hernia repair
The laparoscopic or minimally-invasive approach can be used for most types of hernia repair. A small incision is made to pass the laparoscope which provides the surgeon with a telescope and fibreoptic light with which to create a working space. Two further incisions are made through which to pass the surgical instruments to manipulate and reduce the hernia. The laparoscope requires an incision of about 2cm while the other instruments may require an incision as tiny as 0.5cm. These small incisions usually heal rapidly, cause relatively minor post-operative pain and result in minimal scarring.
The hernia defect is usually repaired with a strong, flexible, multilayered mesh which conforms to the contours of the body and is fixed into place with surgical tacks or stitches. Depending on the characteristics of the hernia, an inguinal defect may be closed with a plug as well as a mesh overlay. These materials are partially absorbed by the body and act as a framework to support new tissue growth over the cavity.
The wounds are sutured with dissolvable sutures.
Laparoscopic versus open hernia repair
Before the development of laparoscopic surgery, hernias were repaired through a single, wide incision. This approach is still used today in selected cases including patients who have had previous surgery in the same area and when unexpected findings during the procedure necessitate conversion of the laparoscopic approach to an open approach.
Laparoscopic surgery generally leads to less time in hospital, a faster recovery and less scarring than the traditional open approach.
Types of hernia
Inguinal (groin) hernia can occur on one or both (bilateral) sides of the groin and is formed when a loop of bowel protrudes through the abdominal wall into the groin. This kind of hernia is best repaired laparoscopically to quickly regain full range of motion and early return to previous activities.
Umbilical hernia occurs near the navel around the area where the blood vessels of the umbilical cord passed during foetal development. An area of weakness can sometimes persist into adulthood and a hernia may form. This can be exacerbated by overweight, coughing, pregnancy and heavy exercise.
Ventral hernia is due to muscle weakness in the upper abdomen.
Incisional hernia is due to a weakness in the abdominal wall from previous surgery when organs or tissues herniate through an old scar.
Femoral hernia occurs when intestine descends into the femoral canal. This canal is the portal for the femoral vein, artery and nerve to travel into the leg. A weakness in its wall can allow intestine to intrude into the space and squeeze the vessels and nerve.