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LAPAROSCOPIC
GROIN HERNIA REPAIR
1. What
are groin hernias?
Hernias are
defects and areas of weaknesses
in the abdominal wall. These
typically occurs in the groin
area and appears as a soft bulge
due to the protrusion of bowel
and abdominal cavity contents
through this defect. This swelling
is small in the beginning and
can be pushed back on lying
down. With time, however, the
hernia invariably gets larger
and may become "irreducible".
When this happens, complications
can occur when the blood supply
to the hernia contents get cut
off.
2. Do
all hernias need surgery?
In the beginning,
the hernia may be small and
totally asymptomatic. It may
not require surgery at this
stage but over time it will
get troublesome. The hernia
will not get smaller on its
own. When they become symptomatic,
they can cause discomfort or
a burning sensation. Surgery
is advisable to avoid complications
from occurring. There is no
other alternative treatment
besides surgery. Using a hernia
belt (truss) was common in the
past, but we now know that this
causes scarring and will eventually
fail when the hernia becomes
too large to be contained.
3. What
happens during hernia surgery?
There are
many ways of performing hernia
surgery. All the procedures
are similar in that they involve
identification of the hernia
sac, reduction of the contents
back into the abdominal cavity
and a reinforcement of the muscular
defect with an inert prosthetic
mesh.
For many years,
the only way we could do this
was with a conventional open
operation. This requires a long
incision that cuts through all
the muscle layers. Recently,
however, we have been able to
do this using the laparoscopic
approach.
4. How
is the Laparoscopic Hernia Repair
done?
In the early
years when we started doing
the laparoscopic repair, we
had to insert the telescope
into the abdominal cavity (the
Trans-Peritoneal Approach) to
perform the operation from inside.
This has certain drawbacks;
hence we now use a newer technique
which does not require entry
into the abdominal cavity (the
Extra-Peritoneal Approach).
The telescope and 2 fine instruments
are placed in the space behind
the muscle layers and the whole
operation is performed using
these keyhole incisions.
5. What
are the advantages of Laparoscopic
Hernia Repair?
Since only
keyhole incisions are used and
a long muscle cut avoided, the
post op pain is reduced and
the return to function is rapid.
Our patients are admitted on
the day of surgery, and can
go home after the operation
(i.e. Day Surgery). Older patients
may require a night's stay for
observation. This operation
is usually done under General
Anaesthesia.
The laparoscopic
repair is definitely superior
to conventional open surgery
if you need surgery on both
sides at the same time (i.e.
a bilateral hernia), or if you
already have a previous open
repair which has failed (i.e.
recurrent hernia). We also recommend
the laparoscopic approach for
patients who are young or those
who are active in sports, have
a physically demanding job,
or simply want a better functional
outcome after surgery. We have
operated on professional sportsmen
(footballers, swimmers etc)
who have gone back to training
a few weeks after laparoscopic
surgery!
6. After
your Laparoscopic Hernia Repair.
Avoid straining
and driving for the first few
days. Walking is encouraged
and a shower is allowed after
48 hours. There may be a slight
swelling around the groin but
this will go away with time
(do not massage it). Good support
with a pair of fitting briefs
is advisable. We will usually
review you a week or two after
surgery to assess fitness for
resuming work. You can usually
go back to exercise after a
few weeks but heavy straining
(eg lifting weights) should
be avoided for a few months.
As with open
surgery, bleeding and infection
can occur. Contact us immediately
if there is severe pain, fever,
bleeding or swelling. Nerve
injury and hernia recurrence
can occasionally occur, but
this seems to be lower in incidence
compared to open surgery. The
risk of this happening in the
long term is probably less than
1%.
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