Groin Hernia (Femoral/Inguinal)

What is Groin Hernia Repair Surgery

Groin hernias include femoral , inguinal and obturator hernias. These hernias have different names based on their anatomical location, however they are all located in close proximity to one another and can be called groin hernias.

 

The principles of repairing these hernias are the same.

 

Surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated in an emergency setting. In some cases asymptomatic patients elect to have hernias repaired even when the risk associated are low.

 

Surgery to repair a hernia usually involves returning the contents of the hernia

to their “normal” position and closing or reinforcing the defect in the abdominal wall through which the hernia occurs.

 

Hernia surgery for groin hernias can usually be performed and the patient able to go home the same day


Types of Hernia Repair Surgery

 

The operation may be performed as an

  • Open Surgery
  • Keyhole or Laparoscopic Surgery
  • Robotic surgery

 
There are reasons why one technique may be recommended over another. This can include;

  • Previous surgery
  • Single or multiple concurrent hernias for repair
  • Current medications and co-existing medical problems
  • Patient preference

 

All techniques have very similar “success” rates with low risk of recurrence.

 

There are two types of Laparoscopic surgery and the most commonly used surgical techniques for hernia repair are:

  • Transabdominal Preperitoneal (TAPP) Repair, and
  • Totally Extraperitoneal (TEP) Repair.


Open Hernia Surgery

About Open Groin Hernia Surgery

Surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated in an emergency setting.

 

Open Surgery

Open surgery for hernia repair can be performed under general or local anaesthesia. Your surgeon makes an incision of approximately 5-10cm long (depending on the size of the hernia) to view and access the surgical site.

 

Your surgeon returns the part of the intestine, fatty tissue or any other structures that protrude through back into normal position and repairs the weakened muscle layer by sewing the edges of the healthy muscle wall together.

 

A synthetic mesh is often placed and sewn over the weakened area to provide additional support and strength, by a procedure called Hernioplasty. The incision is closed after the procedure using dissolvable stitches.

 

Post-operative Care

Following surgery, you

  • Can usually go home the day of the procedure
  • Should avoid driving while taking pain killers as they induce drowsiness
  • Can resume daily activities early but avoid strenuous activities such as heavy lifting for up to 6 weeks
  • Use an ice pack on the wound to reduce pain and swelling

 

Risks and Complications

Like most surgical procedures, hernia repair is associated with the following risks and complications:

  • Reaction to anaesthesia
  • Infection
  • Bleeding at the operation site
  • Nerve damage and numbness of the skin
  • Damage to surrounding tissue

 

Although the recurrence of hernias is seen in less than 5% of patients after surgery, you would need to follow preventive measures.

 

Laparoscopic Hernia Surgery

Why Consider Laparoscopic Hernia Surgery

Benefits of Laparoscopic groin hernia surgery can include less post-operative discomfort, return to normal duties slightly quicker and less risk of wound infection.

 

Surgery is performed via smaller incisions than traditional open surgery. No further incisions are required for patients with hernias in both groins.


Recurrence rates are similar to other techniques.

 

About Laparoscopic Groin Hernia Surgery

Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the abdomen through a small incision. The laparoscope is a small fibre-optic viewing instrument attached with a tiny lens, light source, and video camera.

 

The most commonly used Laparoscopic surgical techniques for groin hernia repair are

  • totally extraperitoneal (TEP) repair and
  • transabdominal preperitoneal (TAPP) repair 


TEP Repair

Totally extraperitoneal (TEP) repair is the most commonly used Laparoscopic technique for groin hernias in Australia.

 

Totally Extraperitoneal (TEP) Repair Surgery is performed under general anaesthesia.

 

Your surgeon makes small incisions below the navel. A balloon is placed in the preperitoneal space (space between the peritoneum and anterior abdominal wall) and filled with gas to separate the layers and expose the hernia.

 

The camera and the surgical instruments are passed through the incisions. Your surgeon exposes the hernial sac, dissects it free from surrounding structures and returns the hernia sac and contents to their “natural” anatomical location. The hernial defect is then reinforced with a synthetic mesh. The incisions are then closed with sutures and waterproof dressings applied

 

The mesh slowly gets incorporated with the tissues of the abdominal wall. The advantage of the TEP procedure is that it reduces the risk associated with damage to the internal organs as it is performed outside of the peritoneum.


TAPP Repair

Transabdominal Preperitoneal (TAPP) Repair surgery is is performed under general anaesthesia.

 

Your surgeon makes a small incision beneath the navel. A 1cm diameter port is inserted into the abdominal cavity and filled with carbon dioxide gas. This allows your surgeon to view the internal organs clearly.

 

A camera is inserted through the port. Further, 2 more incisions on the abdomen are made to introduce the surgical instruments. The peritoneum (a membrane that lines the abdominal cavity) is cut and the contents of the hernia reduced (returned to their normal position).

 

A synthetic mesh is placed over the peritoneal opening to reinforce the defect and then peritoneum is closed. The skin wounds are then closed using absorbable sutures and waterproof dressings applied.

 

The disadvantage of the TAPP procedure is it can cause injury to adjacent abdominal organs. The advantage of the TAPP procedure is that it can be performed on patients who have undergone previous lower midline surgery.


Complications With Laparoscopic Hernia Surgery

Specific complications of Laparoscopic hernia surgery may include

  • local discomfort and stiffness,
  • infection,
  • damage to nerves and blood vessels,
  • Bruising, blood clots,
  • wound irritation and
  • urinary retention.
  • Rarely bowel or bladder injury

 

Post-operative Guidelines

  • Pain medication will be provided and should be taken as directed.
  • Remove the dressings after 5 days. There is no sutures that require removal. These are hidden and absorbable.
  • Swelling in the groin, at the site of a hernia may occur due to serum accumulation in the cavity left by reducing the hernial sac.
  • Bruising usually appears in the genital area, which is not painful and disappears over 1-2 weeks.
  • You are able to drive when you can safely operate the vehicle (i.e. come to an emergency stop without pain or hesitation), and when no longer taking stronger painkillers. Usually within a week
  • A follow-up visit is scheduled 2-6 weeks after surgery to monitor your progress.
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