Repair of other hernia types

The decision on whether to offer an open or laparoscopic repair for a particular hernia type will depend upon a number of factors. For a small umbilical or paraumbilical hernia only a small incision will be required which can often be situated within the bellybutton. The incision is small and inconspicuous and it therefore makes sense to offer an open operation. Epigastric hernias should also be repaired at open operation since the defect cannot be seen from inside the peritoneal cavity. If the wound over the incisional hernia is unsightly and needs to be excised then it is reasonable to offer an open operation. For other incisional hernias, larger umbilical or paraumbilical hernias a laparoscopic repair should be considered.

Open repair of other hernia types

Defects between 1 to 2 cm can be reliably repaired with a few nylon stitches. For larger defects a mesh repair should be performed. The mesh can be placed in front of or behind the defect. The best place to put the mesh, if possible, is behind the defect and in front of the peritoneum. This avoids the extensive dissection between the skin and the abdominal wall (a lot of fluid can collect in this space after the operation) and keeps the mesh away from the bowel. The mesh can be stitched to the edge of the defect or a layer of tissue stitched over it in order to keep it in place.

Laparoscopic repair of other hernia types

A laparoscopic repair of these hernias is performed through the peritoneal cavity. A 15 mm incision is made for the port through which the camera is passed and two other 5 mm incisions for the ports though which the operation will be performed. The position of these ports will depend on where the hernia is. The contents of the hernia are pulled out of the hernia sac and into the abdominal cavity. The mesh used to repair the defect is then prepared. The mesh should be large enough to overlap the edge of the defect by at least 4cm. A double suture is attached to each of the corners of the mesh which is laid on the abdominal wall over the hernia. The position of the corners of the mesh are marked on the skin and a 3mm incision made over the marks. The mesh is then put inside the abdominal cavity and the double sutures drawn out through these small incisions using as special needle. They are then tied down to fix the corners of the mesh. The rest of the mesh is then fixed in place using staples. The wounds are closed with dissolving sutures.