Laparoscopic Inguinal Hernia Repair

Laparoscopic inguinal hernia repair surgery is a surgical procedure used to repair a hernia in the groin area.

Laparoscopic inguinal hernia surgery indications are the same as with open inguinal hernia surgery. A doctor can recommend hernia repair treatment as a result of bilateral inguinal hernia or hernia recurrences. Laparoscopic inguinal hernia reduces the pain experienced by the patient and offers an earlier chance of resuming normal activities.

How is inguinal hernia repair surgery performed?

During inguinal hernia repair surgery, the doctors place the patient in supine position, and with both hands tucked. General anesthesia is used during laparoscopic inguinal hernia surgery. The monitor is set at the foot of the surgery bed.

Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP)

The surgeon makes an infraumbilical incision to access the peritoneal cavity. Trocars are inserted. Once the hernia is visualized, the peritoneum covering it is cut sharply, 3 to 4 cm, superiorly beginning at the medial umbilical ligament to the anterior superior iliac spine.  The surgeons can use a blunt dissection to peal the peritoneal flaps inferiorly. This step exposes the inferior epigastric vessels, the Cooper’s ligament, the pubic symphysis and the iliopubic tract.

If a direct hernia is seen, it should be reduced and indirectly dissected from the cord structures. Obturator and femoral hernias can be visualized and then reduced. Surgeons should be cautious to avoid the “Triangle of Doom,” which contains the external iliac vessels surrounded by the gonadal vessels laterally and the vas deferens medially.

A mesh of a diameter of between 10 and 15 cm made of either polyester or polypropylene is introduced via the subumbilical trocar and placed along the pelvic wall. The center of the mesh should be directly placed over the main hernia defect. Fixation ranges from absorbable to non-absorbable fastening devices to the Cooper’s ligament and the anterior abdominal wall, or with fibrin sealant or no fixation entirely. The lateral abdominal wall should be avoided to prevent entrapping the nerves located at the iliopubic tract. A running suture is used to re-approximate the peritoneum, and the ports are removed under direct visualization. Also, umbilicus fascia defect is sealed under direct visualization.

Laparoscopic Total Extraperitoneal Inguinal Hernia Repair (TEP)

The operative layout of the TEP is similar to the TAPP approach. Surgeons make the infraumbilical incision in the inferior fascia lateral to the alba. The rectus muscle is withdrawn laterally, and this exposes the posterior rectus sheath. The surgeons can use the laparoscopic camera or a balloon dissector to open the preperitoneal space. This step should always happen under direct visualization.

Then the surgeons can use an angled scope to place two 5mm trocars in the infraumbilical midline, and the inferior port should be three fingerbreadths above the pubic symphysis. The dissection and landmarks are similar to the TAPP surgery. Any accidental tears along the peritoneum during segmentation can lead to reduced working space. However, the preperitoneal working space can be maintained through sutures or through the usage of a Veress needle to free the intra-abdominal pneumoperitoneum. If that does not succeed, the entire procedure should be converted to TAPP repair.

Advantages of doing Laparoscopic inguinal hernia repair surgery

Laparoscopic inguinal hernia surgery reduces the pain which patient experiences after surgery. This means that the patient can be discharged on the day following the surgery. Also, inguinal hernia surgery usually allows the patient to resume normal activities within a very short period.

Also performing laparoscopic inguinal hernia surgery reduces the possibility of adhesions forming after the surgery.

Side effects or complications of the procedure

  • Bleeding – laparoscopic inguinal hernia surgery does not pose bleeding risks to the patient, even though there are rare cases of minor bleeding once inguinal hernia surgery is complete. This is mostly caused by collection of blood where the hernia was located. Although this is very rare, it is an established complication.
  • Infections – infections of the surgical incisions or mesh after inguinal hernia surgery are very rare, but they do happen, especially if the patient doesn’t take good care of the incisions. However, the patient usually receives a dose of antibiotics before the surgery starts. Incision infections can be treated with antibiotics or opening the incisions. Mesh infections can only be treated by removing the mesh.
  • Bladder and urine – some patients complain about experiencing urinary retention after undergoing a laparoscopic inguinal hernia surgery. If this ever happens, it can be treated through the use of a temporary urinary catheter, which can be removed within three days. Also, bladder injuries as a result of hernia repair treatment are also rare. Patients with previous prostate surgery should consult with the surgeon before the surgery. Also, there are rare cases of urinary infections which have been reported.
  • Acute and prolonged pain – it is critical for patients to inform their doctors if they have any leg or groin pain before the surgery. Hernia repair treatment usually causes pain in the incisions, which can either be mild or moderate and light discomfort to the groin. This mostly lasts from 2 to 14 days, and the patient should expect the pain to be gone within a month after the surgery.
  • Acute severe groin pain – if a patient experiences acute severe groin pain immediately after hernia repair treatment should seek immediate medical attention as it can be due to reaction of the surgical material used. At times, this can warrant the patient to be taken back to the surgical room for the material to be removed. Also, nerve injury increases the risk of a patient developing chronic groin pain.
  • Chronic groin pain – this can either be mild or severe and is the groin pain or discomfort which extends to over three months after laparoscopic inguinal hernia surgery.

Post-operative care after hernia surgery

  • Diet – there are no special diet restrictions after laparoscopic inguinal hernia repair.
  • Wound care – Usually the dressings applied are water proof and the patient can take a shower on the very next day.
  • Work – patients return to work in different times, depending on how their bodies respond to treatment. However, it is advisable to take about a week off before resuming work.
  • Driving – A patient should be able to drive within 2 days.
  • Seroma – some patients feel like the hernia has returned immediately after surgery. However, there is no need to worry as the place where the hernia was located can at times fill up with fluid. This is normal occurrence after hernia repair treatment and is usually absorbed into the body within several weeks.
  • Pain – male patients should expect their scrotum to become slightly tender and swollen after hernia repair treatment. In this case, ice packs can prove to be very useful, and the feeling is supposed to go away within few weeks.

Hernia surgery cost

Laparoscopic inguinal hernia repair is a very complicated procedure, and the cost of inguinal hernia repair surgery is determined by a number of factors. The primary determinants of laparoscopic inguinal hernia repair surgery cost include the type of hospital and room selected. The average cost of laparoscopic inguinal hernia repair surgery also depends on the duration of surgery. The cost of hernia repair treatment also depends on the type of mesh used. The cost of inguinal hernia surgery is covered routinely under insurance. In addition, inguinal hernia repair surgery cost  may depend on whether the surgery is a TAPP or TEP.