WHY SHOULD A HERNIA BE REPAIRED?
Surgery should be considered for a hernia if is causing symptoms which are interfering with your quality of life and general wellbeing, preventing you from doing the kind of activities you would like to be doing, or are a source of potential risk to your health.
WHAT DOES SURGERY AIM TO DO?
The aim of surgical repair of a hernia is to restore the integrity of the abdominal wall by closing the defect. Where necessary this is re-inforced this with synthetic material (mesh) placed over the area of weakness. The mesh acts as a framework for the body’s natural tissues to grow into, making the area of repair much stronger, reducing the risk of the hernia returning (recurrent hernia).
This approach is often referred to as a tension-free repair. It allows the abdominal wall to recover its natural strength and flexibility and not just rely on the stitches in the repair alone.
HOW IS THE SURGERY PERFORMED?
An abdominal wall hernia can be repaired from the outside (open) surgery or from the inside by keyhole (laparoscopic) surgery.
Open Hernia Surgery
The standard and traditional approach to repairing abdominal wall hernias has been to make an incision over the area of weakness. This incision has to be wide enough and deep enough to allow access to and around the defect.
The hernia sac, which is like a bag containing the internal organs, is freed to enable these to return back to the abdomen safely. The excess sac is usually excised or inverted.
The defect is then closed or reduced in size using stitches and then the synthetic mesh is placed over this area, which is usually stitched or tacked to keep it in position. Recovery is very quick, and in most cases patients are able to go home on the same day, but this will depend on the type of hernia.
Laparoscopic Hernia Surgery
Keyhole surgery aims to repair the defect from the inside of the abdomen.
This involves the making of usually three small (two 12mm, one 5mm) incisions on the abdomen, at some distance away from the hernia rather than directly over it.
These incisions allow the insertion of special instrumentation, which are then used to expose the same defect from the inside.
The internal organs and hernia sac are pulled out of the defect, and the area between the muscular abdominal wall and inner most lining (the peritoneum) is exposed.
A mesh is then placed over this area and is secured in place using a fixation device so that it lies above the peritoneum, but under the muscle. This prevents internal organs, specifically the bowel from sticking to the mesh.
Recovery is quick, with most patients being able to go home on the same day. Not all hernias or all patients are suitable for laparoscopic surgery.
Our patients say . . .
I would like to thank you so much for your help skill and expertise in dong this [abdominal wall hernia repair] and giving me my life back.
My husband and I would like to thank you for all you effort curing my hernia problem … my breathing is much improved. I look forward to a much better quality of life.
SHOULD I HAVE OPEN OR KEYHOLE SURGERY?
This is a very good question, which patients always ask. The answer depends on the kind of hernia you have, whether you have any other medical issues, and what your personal preference is. Both techniques have benefits and risks, so this is something that you will need to discuss with your specialist and then decide which is right for you.
Below are some of the things to consider for each type of procedure.
What is the recovery like?
Both procedures, in simple cases are associated with a quick recovery and return to normal activities rapidly. Because smaller incisions and less dissection of the abdominal wall is required in the laparoscopic technique, this does tend to result in less pain and so a quicker recovery.
However, for simple hernias, and when only one side is being operated on, the difference between post-operative pain about the same for each procedure. If both sides (bilateral hernia) are being operated on, then laparoscopic surgery is advantageous, because both sides can be operated through the same incisions, whereas two separate incisions are required in open surgery.
Laparoscopic surgery is also preferable in recurrent hernias, when the original operation has been performed by the open technique. This avoids dissected through previous scar tissue which can be difficult and cause more post-operative pain. Conversely, if the original operation was performed by laparoscopic surgery an open operation is preferable What are the risks and problems with each procedure?
Both open and laparoscopic surgery is usually performed by a general anaesthetic which has its own risks. In some cases local anaesthetic may be used for an open operation. All operations carry risks of bleeding, bruising and infection.
Laparoscopic surgery is a more complex and slightly riskier procedure because it needs to be performed from inside the abdomen. This involves a deeper anaesthetic to fully relax the muscles and create a space to perform the surgery. There is also the risk of damaging internal organs (visceral injury) such as bowel or large blood vessels as instruments are being placed directly inside the abdomen. Open surgery does not normally come into direct contact with these structures.
Open hernia operation does involve dissecting through the outer layers of the abdominal wall and this can generate scar tissue which can impinge on nerves and a small number patient can develop troublesome chronic pain. This may be less common with laparoscopic surgery, although the dissection of the tissues also creates scar tissue and there can be some pain associated with the fixation device. Bowel adhesions can also form to the site of the operation from the inside that can be a source of discomfort.
WHAT ARE THE OUTCOMES OF HERNIA SURGERY?
Excellent results can be achieved from both open and laparoscopic hernia surgery and there is actually little choose between them. Since the incorporation of tension-free and mesh techniques, recurrence is rare, and the expectation is that the repair will be permanent.
Which technique is best for an individual is decided following a detailed assessment and discussion with a specialist hernia surgeon.