Laparoscopic Inguinal/Femoral Hernia Mesh Repair

Introduction

A hernia occurs when the internal organs of the abdominal cavity push through a weakened spot in the abdominal wall to form a bulge. Hernias occur most commonly between the area of your rib cage and groin.

Hernias may be repaired surgically by closing the defect and using mesh to strengthen the weakened area. This can be performed in a minimally invasive manner using a laparoscope.

Disease Overview

An inguinal hernia is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin or into the scrotum or testicular sac.

A femoral hernia develops just below the lower abdomen and upper thigh, near the groin crease or skin folds around the vagina. The bulge pushes into the femoral canal through which nerves and blood vessels run into the thigh region.

Inguinal hernias commonly occur in men while femoral hernias are uncommon and mostly seen in women.

Hernias generally do not cause any symptoms, but may be discovered on a routine medical exam. Symptoms may include pain, aching, discomfort, or a heaviness in the groin. The bulge formed is more prominent when you stand, cough or strain, and may disappear while lying down as it slips back into the abdomen.

A hernia can sometimes become trapped or strangulated and cannot be pushed back into the abdomen. This is referred to as an irreducible hernia. It is a dangerous situation where the blood supply to the hernia is compromised and may require emergency surgery.

Indications

Small hernias that do not cause any symptoms are usually not treated but instead your doctor may follow a wait-and-watch approach.

Surgery is recommended for hernias that show symptoms, are enlarged or entrapped. Surgery may involve an open hernia repair with a larger incision or laparoscopic surgery, a minimally invasive approach with smaller incisions.

Laparoscopy is especially advised for patients with recurring hernias, bilateral inguinal hernias and femoral hernias. However, it is not recommended for patients with very large hernias, strangulated hernias, prior pelvic surgery and intolerance to general anesthesia. These would typically require an open approach.

Surgical Procedure

Laparoscopic hernia repair is performed under general anesthesia. Your surgeon will make a few small incisions in your abdomen or groin through which a thin tube called a laparoscope and other special instruments are inserted. A video camera attached to the laparoscope sends magnified images to a monitor guiding your surgeon throughout the procedure. Your surgeon will push the bulge back into the abdomen and either stitch the abdominal wall or use a mesh to support the weakened wall.

Post-Operative Care

Laparoscopic repair of inguinal or femoral hernia is usually performed as an outpatient procedure so you will return home as soon as you recover from anesthesia. You may have some swelling or bruising at the incision sites which is normal. Pain and swelling are mostly controlled with medications. It is important to avoid strenuous activity or heavy lifting for at least 2 weeks after the procedure.

Advantages & Disadvantages

Laparoscopic hernia repair is a minimally invasive procedure and as such is associated with less tissue damage and pain and a faster recovery compared to the open approach. This surgical approach allows you to return home the same day and get back to your regular activities sooner.

Risks and Complications

As with any surgery, complications may occur. Complications related to laparoscopic hernia repair include:

• Groin pain due to nerve injury
• Infection at the incision site or mesh
• Blood or fluid accumulation
• Urinary retention

Summary

Hernia is a common condition that occurs when an internal organ pushes through a weakened area in the musculature or tissue lining. Surgical repair is recommended for hernias that cause pain and for irreducible hernias that are incarcerated or strangulated. The goal of surgery is to reduce the hernia, close the opening and repair the muscle wall through which the hernia protrudes.