Laparoscopic Hernia Repair
Specialized small cameras and instruments are used to perform laparoscopic surgery. Tiny incisions are made through the abdominal wall via trocars (surgical instruments with a cannula or tube).
Laparoscopic hernia procedures can be done as an outpatient procedure, meaning that the patient is released the same day. During the initial surgical consultation, patients who may be appropriate for a laparoscopic approach to repair their hernias are carefully selected, after reviewing their prior medical and surgical history. Laparoscopic repair is commonly performed because of recurrent hernias (umbilical, incisional or inguinal) or multiple hernias of the abdominal wall. A personalized discussion with the surgeon will determine the correct type of procedure for you.
Benefits of laparoscopic surgery may include:
- Quicker recovery and return to work
- Less pain
- Smaller incisions
- Lower rates of wound infection
Laparoscopic Ventral/Incisional Hernia Technique
Laparoscopic surgery requires general anesthesia (endotracheal intubation). The abdominal cavity is insufflated with carbon dioxide (CO2) gas to allow full expansion of the abdominal cavity and visualization of the hernia defect(s). CO2 gas is used as it is non-flammable and highly soluble. Several trocars (usually three to four) are inserted through the abdominal wall via tiny incisions, each about the width of a pencil. These small incisions reduce the incidence of pain and lower the chance of infection.
Laparoscopic instruments (such as cameras, graspers and scissors) are then used to carefully dissect free and reduce the hernia contents from the hernia defect or multiple defects. The size of the hernia defect is then measured and an appropriately sized mesh is chosen to cover the defect well beyond its edges. We individually select the appropriate mesh product (selecting the precise size, shape, and configuration) at the time of surgery that is best suited for each hernia. This method of intra-peritoneal onlay mesh (IPOM) placement is then carefully secured in place to the abdominal wall using dissolvable tacks and trans-fascial sutures. Patients are usually comfortable and discharged home within one to two hours after the surgery.
Laparoscopic Inguinal Hernia Technique
Laparoscopic surgery requires general anesthesia (endotracheal intubation). The abdominal cavity is insufflated with carbon dioxide (CO2) gas to allow full expansion of the abdominal cavity and visualization of the hernia defect. CO2 gas is non-flammable and highly soluble. Three trocars are inserted through the abdominal wall via small incisions. The small size of the incisions reduces the incidence of pain and lowers the rates of infection.
During the Transabdominal Preperitoneal (TAPP) approach, the membrane lining the inner abdominal wall (peritoneum) is incised above the inguinal hernia defect. The peritoneum is dissected away from the rectus abdominus muscle to identify the hernia (bulge), which is then carefully dissected free from all structures in the pre-peritoneal space. A specially designed mesh is positioned to cover and effectively repair the defect from the inside of the abdominal wall. This mesh extends well beyond the edges of the defect to reduce pressure on the hernia defect opening, and reinforces the entire hernia-prone area (called the Myopectineal Orifice). The mesh is secured in place without tension using dissolvable tacks, and the peritoneum is closed over the mesh. The intestines are fully protected afterwards by the peritoneum, as this membrane is positioned between the inserted mesh and the intestines. Patients are usually comfortable and discharged home within one to two hours after the surgery.