Laparoscopic Inguinal Hernia Repair - Procedure and Recovery

Laparoscopic inguinal hernia repair is a minimally invasive surgical procedure for repairing hernias in the groin area.  Instead of a large incision, small keyhole-sized openings are made in the abdomen, allowing the surgeon to insert a camera. This approach offers advantages such as reduced post-operative pain and faster recovery times. 

Anatomy of the Inguinal Region

The inguinal region, located in the lower abdomen. The anatomy is as follows:

1. Inguinal Canal: A passage in the lower abdominal wall that contains the spermatic cord in men and the round ligament of the uterus in women.

2. Spermatic Cord (in males): It contains structures such as the vas deferens, testicular arteries, veins, lymphatics, and nerves.

3. Inguinal Ligament: A band of fibrous tissue that runs from the anterior superior iliac spine to the pubic tubercle. It forms the inferior border of the inguinal canal.

Laparoscopic inguinal hernia repair is commonly used to treat various conditions related to inguinal hernias causing discomfort, pain, or tenderness. It is also recommended for:

1. Incarcerated Hernias: When a portion of the abdominal contents becomes trapped within the hernia sac and cannot be reduced back into the abdominal cavity.

2. Strangulated Hernias: A serious complication where the blood supply to the trapped abdominal contents is compromised, leading to tissue damage. 

3. Paediatric Inguinal Hernias: Surgery is recommended for inguinal hernias in children to prevent complications such as incarceration or strangulation.

4. Recurrent Hernias: It is effective for repairing recurrent hernias, which occur when a previously repaired condition returns. 

A laparoscopic hernia operation time of completion is around 30 minutes. Bilateral repairs take less than an hour. Before the surgery, patients undergo pre-operative assessments and instructions to avoid any complications. 

Before Surgery 

Before laparoscopic hernia surgery, patients may receive preoperative antibiotics to reduce the risk of infection and blood clots during the procedure. 

On the Day of Surgery

On the day of lap hernia surgery, patient should wear loose-fitting clothes to stay comfortable in the hospital.

There are two basic procedures for laparoscopic hernia surgery: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP). Both procedures are similar; however, in TAPP, the peritoneum (abdominal membrane) is cut, necessitating closure following mesh placement. On the other hand, TEP is done completely outside the peritoneum. 

1. Preparation: The patient is placed in a supine position with both arms tucked. Three small incisions are made in the abdomen, and carbon dioxide gas is introduced to create space.

2. Placement of Trocars: Hollow tubes are inserted through the cuts, providing access to the laparoscope (a thin tube with a camera) and surgical instruments.

3. Visualisation: The laparoscope is inserted through one of the trocars, allowing the surgeon to see the hernia and surrounding anatomy on a monitor.

4. Reduction of Hernia: The hernia sac is cut and reduced back into the abdominal cavity.

5. Mesh Placement: A patch is then placed over the hernia defect to reinforce the weakened area and prevent recurrence.

6. Closure: Once the mesh is securely in place, the trocars are removed, and the incisions are closed with sutures or surgical glue.

After keyhole surgery for hernia, patients experience mild discomfort and may be prescribed pain medication as needed. The healing process includes the following: 

The Recovery Process in Hospital

During the recovery process in the hospital following laparoscopic hernioplasty, patients would require someone to take them home. As it is an outpatient procedure, individuals are discharged within 3-6 hours once they can walk without experiencing dizziness. 

Recovery Process/Expectation after Hospital Discharge

After hospital discharge, the inguinal hernia surgery recovery time can be anywhere around 1 to 2 weeks. The guidelines to keep in mind during this phase are:

1. Gradually return to light activities and normal routine after 1 to 2 weeks.

2. Strenuous exercise should be avoided for at least 4 weeks.

3. With doctor approval, patients may be allowed to shower 24 to 48 hours after surgery, being careful to pat the incision dry.

First Follow-Up Appointment

After inguinal hernia laparoscopic surgery, patients are advised to schedule a follow-up appointment with their surgeon after 7 days. During this initial post-operative visit, the surgeon will assess the patient's recovery progress and evaluate the surgical site.

When comparing open mesh vs laparoscopic mesh repair of inguinal hernia, the latter approach offers several benefits, including a low recurrence rate of around 0% to 2%. The key advantages include:

1. Involves smaller incisions, resulting in less tissue trauma and reduced post-operative pain.

2. Minimal scarring, providing improved cosmetic outcomes.

3. Lower rates of complications that are less than 4%.

While generally safe, inguinal hernia laparoscopic surgery carries certain complications. Seroma (fluid accumulation) and haematoma (blood pooling) are common post-surgery occurrences. Other risks include:

1. Infection at the surgical site

2. Persistent or chronic pain

3. Injury to nearby nerves during surgery

When to consult a doctor?

Following a laparoscopic hernia operation, patients should promptly consult a doctor if they experience any concerning symptoms. Early detection and management of complications are crucial for ensuring optimal recovery. Common reasons to consult a professional include:

1. Pain that does not improve or worsen over time

2. A fever above 100.4 F may be a sign of infection

3. Any signs of increased redness, warmth, or drainage from the surgical site

4. Excessive or rapidly increasing swelling

5. Difficulty urinating or changes in bowel habits

With time, the hernia may enlarge, making it more challenging to repair and increasing the risk of complications during surgery. It raises the likelihood of the hernia becoming incarcerated (trapped), which can progress to strangulation. In this condition, the blood supply to the trapped tissues is cut off.  

Cost of Laparoscopic Inguinal Hernia Repair

The cost of keyhole surgery for hernia can vary widely depending on factors such as the specific hospital or surgical centre chosen. In general, the price include:

Note: The figures mentioned above are just an estimate. Contact HexaHealth to get precise information.

Factors that may affect the cost of laparoscopic hernia surgery include:

1. Surgeon's Fees: The experience and expertise of the doctor performing the procedure can affect the cost. Surgeons with advanced training or specialisation may charge higher fees.

2. Pre- and Post-Surgery Evaluations: Pre-operative consultations, laboratory tests, imaging studies, and post-operative care may incur extra expenses.

3. Additional Interventions: Unexpected complications during surgery or post-operative care may require medical interventions. This can increase the overall cost of treatment.

Laparoscopic inguinal hernia repair offers a minimally invasive approach to addressing hernias in the groin area. Patients undergoing this procedure can expect smaller incisions, shorter hospital stays, and quicker return to normal activities. However, navigating the complexities of healthcare, including finding the right surgeon, can be challenging.

HexaHealth streamlines the process by connecting patients with experienced doctors who specialise in lap hernia surgery. Through our platform, patients can easily schedule consultations and verify insurance coverage. Get in touch!

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