Laparoscopic inguinal hernia surgery: step by step

• Laparoscopic inguinal hernia surgery is the minimally invasive alternative to conventional (open) surgery.
• With the laparoscopic technique, recovery will be much faster and the surgical wound will be hardly noticeable.
• The laparoscopic inguinal hernia operation takes between 45 minutes and 1 hour.

Laparoscopic inguinal hernia surgery is a minimally invasive procedure, performed through 3 or 4 mini incisions in the abdomen. Its advantages include rapid recovery and little postoperative pain.

The laparoscopic technique is suitable for treating bilateral inguinal hernias and hernias that have recurred after surgical repair.

During the surgical intervention, general anaesthesia is used, so if you are intolerant, the specialist will not recommend the surgery. 

Surgical mesh will be placed to repair and reinforce the hernia defect.

Once the surgery is finished, you will be able to return home after 24-48 hours and return to work after 2 weeks.

Laparoscopy is a minimally invasive surgical technique that is performed through 3 - 4 mini incisions in the abdomen, to treat different conditions. 

The laparoscope is a thin tube, i.e. an endoscope with a micro-camera inserted. 

This tube is inserted through one of the mini incisions and allows the surgeon to see inside the body with a panoramic view of the organs, without causing injury to the patient.

Laparoscopic surgery is a minimally invasive alternative to open surgery.

The laparoscope transmits images of the organs to a monitor, through which the specialist can be guided to perform the surgical procedure. The images that this instrument sends to the monitor are large, in relation to their actual size, which allows a better view and, consequently, a reduction of error in the manoeuvre.

The advantages associated with laparoscopic surgery come from the technique itself. As there is no large incision, as in conventional surgery, not only will the scar be almost imperceptible, but recovery will be much quicker.

In addition, laparoscopic inguinal hernia surgery has the following advantages:

• Minimally invasive surgery
• Less need for hospitalisation, being 24-48 hours in most patients.
• Faster recovery
• Less postoperative pain
• Reduces the possibility of hernia recurrence (recurrent hernia).
• Barely noticeable scar
• Early return to daily activities, in about 2 weeks,
• Lower complication rate: infections, haematomas, etc.

To find out whether or not you are a candidate for laparoscopic inguinal hernia surgery, you need to see a specialist to ensure that it is the ideal technique.

However, the medical literature, i.e. the studies that have been carried out on the subject, state that the laparoscopic technique is the best option for treating inguinal hernias. But in which cases is laparoscopic inguinal hernia repair optimal?

• Bilateral inguinal hernias (left and right): laparoscopy makes it possible to treat two conditions from the same port of entry (incision).
• Recurrent hernias: one of the risks of open surgery is the recurrence of the inguinal hernia. If this happens, laparoscopy is usually used to re-intervene the hernia inside the abdominal wall.
• General anaesthesia: the operation is performed with this type of anaesthesia, so you must be tolerant to general anaesthesia.
• Previous abdominal surgery: if you have already undergone surgery in the pelvic area, laparoscopic surgery will be the best option, thanks to its minimally invasive technique.

However, in any case, it is up to the specialist to assess whether or not laparoscopic surgery is appropriate.

In which cases is laparoscopic surgery for inguinal hernia not recommended?

Not all inguinal hernias can be repaired with laparoscopic surgery, as it is a procedure that requires the use of general anaesthesia. Therefore, if for some reason you cannot tolerate the medication, open surgery will be necessary to repair the inguinal hernia.

In addition to anaesthetic tolerance, there are several circumstances that preclude laparoscopic surgery for inguinal hernia repair:

• Incarcerated hernia
• Intolerance to anaesthesia
• Bleeding disorders such as haemophilia, etc.
• Ingestion of medications that prevent blood clots
• More than 2-3 previous abdominal surgeries, as scar tissue can complicate the use of the laparoscope.
• Severe lung disease. In some cases, the carbon dioxide used to inflate the abdomen during surgery can interfere with breathing.
• Pregnancy
• Obesity

However, it will be the specialist who, in any case, will recommend one technique (laparoscopy) or another (open) to repair the inguinal hernia, depending on: the state of the hernia you have and, above all, your state of health.

Laparoscopic approaches have the advantage of making smaller incisions and solving the problem of inguinal hernia from the internal side of the defect, i.e. inside the abdominal wall.

This surgery can be performed using the following techniques:

• Transabdominal Peritoneal Technique (TAPP): the abdominal cavity and the hernia defect are accessed from its posterior part, placing the surgical mesh in the preperitoneal space.
• Total Extraperitoneal Surgery (TEP): the mesh is placed between the musculature and the peritoneum, over the rupture point. The anatomical structures fix the mesh, so no additional support is required.

So, the step-by-step of laparoscopic inguinal hernia surgery is:

• First, an intravenous line is placed and you may be given a sedative to relax you.
• The anaesthetist then injects the medication into the general anaesthetic so you won't feel anything during the operation.
• A catheter may be inserted into your bladder to drain urine.
• Three small incisions are made, about 0.5 - 1 cm in size, at the level of the navel. 3 trocars are used for this.
• Carbon dioxide is pumped through one of the ports to inflate the abdomen so that the contents can be clearly visualised.
• The laparoscope is then inserted through a cannula (small hollow tube). This instrument has a camera inserted, connected to a monitor, through which the surgeon can see the abdominal organs.
• The specialist will pass the rest of the necessary instruments through the other ports.
• Once inside, the hernia sac is returned to its original position.
• Surgical mesh is placed in the inguinal hernia hole, preventing the intestine from retracting through the hole.
• The specialist checks the abdominal area for bleeding or other damage to repair.
• Finally, the laparoscope is removed and a valve is left in one of the ports to remove all the carbon dioxide from the abdomen.
• Finally, the mini incisions are closed with sutures or staples and a bandage is applied.

The catheter is removed and you will be transferred to the recovery room. In some cases, medication will be administered to alleviate minor discomfort that may arise. As soon as you are able to take fluids, the intravenous line will be removed.

But what happens if the surgery cannot be completed using the laparoscopic technique?

In some cases, once the laparoscopic surgery has begun, it is not possible to complete it for technical reasons: adhesions, difficulty in accessing the groyne area, etc. In these unsafe cases, the surgeon will convert the intervention into conventional surgery (open surgery), ensuring the patient's health.

Only 5% of laparoscopic surgeries are converted to open surgery.

For this reason, it is essential that the specialist is the one who, through a thorough examination, determines the surgical procedure that best suits your health.

Therefore, if you have your doctor's recommendation to surgically repair your inguinal hernia, Operarme offers you an initial surgical assessment consultation with one of our specialists. In this way, he or she will be able to determine whether laparoscopic surgery is the best option in your case.

Laparoscopic inguinal hernia surgery lasts 45 to 60 minutes. 

However, the need for surgical time is influenced by variables such as the type of hernia (bilateral, recurrence, etc.), medical condition and patient profile, size of the inguinal hernia, surgical history, etc.

Once the surgery is over, you will leave the hospital 24 - 48 hours after the surgery.

So, from the time you leave the hospital until you go for your medical check-up, the recovery process will be as follows:

• Immediately after the intervention, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you wake up.
• When you recover from the effects of the anaesthesia, you will have to get up to urinate, walk around and start to tolerate liquids.
• If you feel no discomfort, you should be discharged within 24-48 hours.
• The specialist will prescribe painkillers to alleviate any discomfort that may arise during the first 4 - 5 days.
• You will be able to return to your normal activity in a few days and to exercise after 2 weeks.
• After showering, you should dry the wounds well and dress them with Betadine to improve healing.

As with any intervention, complications can also arise with laparoscopic inguinal hernia surgery. Thus, some of the risks associated with laparoscopic inguinal hernia surgery are:

• Bleeding and infection, although these are very rare.
• Possibility of injury to the bladder, intestines, blood vessels or sperm duct.
• Difficulty urinating after surgery. Although unlikely, if this happens, a catheter will be placed in the bladder for at least a week.
• There is always a chance of recurrence of inguinal hernia, regardless of the technique used for the operation.

The complication rate after laparoscopic inguinal hernia surgery is low.

Therefore, it is important that it is the specialist who determines, after the appropriate examination and study, which technique entails the lowest percentage of risk in your case.

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• López de Victoria, J. C. (2018, septiembre). Errores más comunes en hernias laparoscópicas. Recuperado de https://medicinaysaludpublica.com/wp-content/uploads/2018/09/Errores-m%C3%A1s-comunes-hernias-laparosc%C3%B3picas.pdf
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