Repair of Inguinal hernias

Open repair of inguinal hernias

The operation can be performed under local (injection of local anaesthetic into the wound, regional (spinal or epidural) or general anaesthetic (the patient is asleep). If the operation is performed under a general or regional anaesthetic the surgeon will infiltrate local anaesthetic into and around the wound after the patient is asleep but before starting the operation to ensure that they are pain free when they wake up. An 8 cm incision is made in the groin and the hernia exposed. Depending upon the nature of the hernia, the hernial sac (literally a sac of peritoneum containing the content coming into the hernia from the abdominal cavity} is cut out or stitched back. A plastic mesh is placed over back wall of the inguinal canal (the area through which hernias comes) to ensure that the hernia does not come back, and is stitched in place. The wound is closed with a dissolving stitch.

Laparoscopic repair of inguinal hernias (TEP technique)

(See how can a hernia be repaired? in frequently asked questions for an explanation of the different types of laparoscopic repair available).

In order to be able to perform this procedure it is necessary for the muscles of the abdominal wall to be fully relaxed and therefore the operation must be performed under a general anaesthetic (the patient must be asleep). Before making any cuts local anaesthetic is infiltrated into the skin and underlying tissues to ensure the patient is pain free when they wake up after the operation. The operation is performed through three small cuts 15mm, 10mm and 5mm in size made in the abdominal wall. A “balloon” is inserted through the largest of these cuts, which is just below the umbilicus, into the space between the abdominal wall and the peritoneum (the sac that covers and contains the abdominal organs}. When the balloon is blown up a space is created between the abdominal wall and peritoneum {extraperitoneal space) . It is in this space that the operation is performed. The balloon is removed and replaced with a port (essentially a plastic or metal tube with a small tap through which carbon dioxide gas is introduced and which has a valve on top which allows instruments to be inserted and removed from the abdomen without the gas escaping) and the extraperitoneal space is blown up and held open with carbon dioxide gas. The two other ports are now inserted and the operation proper can begin. Inguinal hernias are described as direct (seen on the left side of this illustration) or indirect (seen on the right side of this illustration) depending on where the weakness is. The type of hernia is then separated from the surrounding tissue and pulled back into the extraperitoneal space. The plastic mesh is then inserted and tacked over the hole left after the direct or indirect hernia has been returned to the extraperitoneal space. The ports are removed and the wounds closed with a dissolving stitch.