Hernia Repair

Hernia is due to a defect in muscle wall

A hernia is a weakness in the abdominal muscle wall through which abdominal contents (intestines or other parts of the bowel) protrude out to cause a bulge over the groin. Inguinal hernia is the commonest and occur especially in men; with up to third developing on both sides. Elderly men are at higher risk of getting hernias, although younger men can also get them if they are into strenuous physical activities. The hernia causes discomfort and even pain if its contents become stuck. Even if it does not become stuck, hernias tend to enlarge over time and will eventually need surgery.

The only way to stop the hernia from becoming worse is to repair the defect surgically. The repair can be done by conventional (open) or laparoscopic (key-hole) surgery.

Open Surgery

An incision is made over the groin. After splitting the muscle layer, the hernia sac is opened and the intestine / contents are pushed back into the abdomen. The weakened area is repaired and the defect is reinforced with a synthetic mesh or with sutures. The surgery usually takes less than1 hour.

Mesh repair in open hernia surgery

Laparoscopic Surgery

Hernias can also be repaired through small incisions. Here, 3 small cuts are made over the midline. The Totally Extra-peritoneal (TEP) method is preferred as it does not enter into the abdominal cavity – hence avoiding any risk of bowel injury or bowel getting stuck to the mesh. After reducing the inguinal hernia, a large mesh is placed and tacked down to cover the defect. Advantages of this technique include faster recovery time, small scars and less postoperative pain. Patients can usually resume normal activity by 1 week.

The other advantage of laparoscopic repair is that bilateral hernias can be repaired through the same 3 keyholes without the need for a second large incision as with the open method.

The disadvantage is that general anesthesia is needed for laparoscopic repair whereas open hernia repair can be done under spinal anaesthesia. Large and irreducible hernias may not be suited too. Laparoscopic method cost more because of the added cost of the laparoscopic instruments and consummeables.

Mesh used in laparoscopic hernia surgery

Complications include:

  • Pain and swelling over the groin (more common in open surgery).
  • Fluid (seroma) or blood clot (haematoma) in the scrotum or the inguinal canal.
  • Inability to urinate(urinary retention) especially in men with enlarged prostates.
  • Infection of the mesh/ wound.
  • Injury to blood vessels and nerves.
  • Numbness over the groin(more common in open method) – this resolves by 1 month.
  • Testicular atrophy(rare).
  • Recurrence of hernia.

Desired outcomes :

  • No recurrence<1% )
  • Wound infection ( <3%)
  • No haematoma5% occurrence )