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Hernia, inguinal repair - How it is performed

NHS Choices Medical Reference

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There are two ways that an inguinal hernia repair can be carried out: open surgery and laparoscopic (keyhole) surgery. The operations are usually carried out under general anaesthetic (where you are unconscious throughout the procedure).

Open surgery

  • The surgeon makes a large (6cm) cut in your groin area.
  • The inguinal canal (channel near your bowel) is opened to return the loop of bowel to your abdomen, where it belongs.
  • The canal is closed with stitches to repair the weak spot that let the hernia through.
  • The wall of your abdomen may be strengthened by fixing a patch of nylon mesh to it.
  • If the hernia has become strangulated (trapped) and part of the bowel is damaged, the affected segment may need to be removed and the two ends of healthy bowel rejoined. This is a more complex operation and you may need to stay in hospital for four to five days.  

Laparoscopic (keyhole) surgery

With laparoscopic surgery, your surgeon makes three very small cuts in your abdomen (a large cut is not needed) and inserts special instruments to pull the loop of bowel back into place.

There are two types of keyhole surgery:

  • Transabdominal preperitoneal (TAPP) - instruments are inserted through the muscle wall of your abdomen and through the lining covering your organs, called the peritoneum. A flap of the peritoneum is peeled back over the hernia and a piece of mesh is stapled to the weakened area in your abdomen wall, to strengthen it.
  • Totally extraperitoneal (TEP) - this is the newest keyhole technique. The hernia is repaired without entering the peritoneal cavity. It is more difficult to do, but there may be less risk of damaging organs in the abdomen. There is no difference in the results.

Which operation is for me?

The National Institute for Health and Clinical Excellence (NICE), which assesses medical treatments for the NHS, says that both keyhole and open surgery for hernias are safe and work well.

Both types of surgery have advantages and disadvantages (see box). Keyhole surgery tends to have a quicker recovery time and results in less pain after the operation, but the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher than in open surgery.

The risk of your hernia returning is similar for both operations. You should discuss the advantages and disadvantages of both keyhole surgery and open surgery with your surgeon before deciding on the most appropriate treatment for you.

Your choice will depend on:

  • Whether you can have a general anaesthetic. Elderly people or those in bad health may be too weak or frail to safely receive a general anaesthetic, so may be advised to have open surgery, which can be done under local anaesthetic (where the area is numbed).
  • The experience of your surgeon. Open surgery is more common than keyhole surgery, partly because not all surgeons have enough experience in keyhole techniques. According to NICE, a surgeon is inexperienced if they have done the operation fewer than 20 times.

NICE recommends that keyhole surgery should always be considered if the hernia has been repaired previously and comes back (recurrent hernia), and for hernias that occur in both sides of the groin (bilateral hernia).

Keyhole surgery is especially useful if your surgeon is not sure what type of hernia you have.

Hernia repairs take about 45 minutes to perform. You can usually go home the same day, but some people stay in hospital overnight if they have other medical problems or live alone.

Medical Review: November 30, 2009
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