Laparoscopic surgery

(Laparoscopic inguinal hernia repair)

Laparoscopic surgery is often referred to as "minimally invasive”.  “Minimal access” is probably a better term because although the 2 or 3 access or entry holes are small a lot is done inside – the operation itself is still pretty ‘invasive’. Like painting your hallway through the letter box – you can do a lot of damage if you don’t do it right.

During this type of surgery, between two and four small incisions are made in the skin so that instruments and a camera can be inserted into the abdomen.

 

The abdominal cavity is then inflated with a gas (carbon dioxide) to give the surgeon space to work inside the patient.


 

 

The camera has a light that gives the surgeon a view from the inside that he / she watches on a television screen and the actual operating is done ‘remotely’ with long instruments which have been passed through the other holes or entry ports.

The advantage put forward for laparoscopic surgery is that no large cut is made on the abdomen,so in theory there is less post-op pain and a quicker return to normal activities.  So for major bowel surgery, where large cuts have traditionally been made, the laparoscopic  option is a good one.  But for inguinal hernia repair the cut for the open local anaesthetic repair is small anyway, so the difference is not at all significant.

In practice you can get quite a lot of pain after a laparoscopic inguinal hernia repair, because the pain does not come from the skin cut anyway. The pain may be related to the fact that the deep tissues have been cut and pulled, and also staples may have been used to fix the mesh.

When done well, by well trained experienced surgeons in appropriately selected cases the results of keyhole inguinal hernia repair can be excellent.  The problem is that well trained experienced surgeons are few and far between. 

What are the disadvantages of the keyhole repair.

  • It is technically demanding. What that really means is that its difficult to learn and difficult to do well. There is what we euphemistically call a ‘learning curve’. You have to practice a lot and do a lot to get good at it.
  • You do have to have a general anaesthetic.  Not so good if you are elderly or have other medical conditons
  • There is the risk of major organ damage – blood vessel, bowel and bladder.  

    * (Just as an aside – you know in the UK and soon Europe, we are not allowed to learn on anaesthetised animals, such as pigs, which inside are anatomically very similar to humans. We are however allowed to learn on humans!)

Situations when laparoscopic inguinal hernia repair is an option

  1. When there has been a previous failed open repair, with a cut on the skin, particularly if mesh was used.
  2. If there is an inguinal hernia on both sides – left and right – and both are to be repaired at the same time.

NICE has made the following recommendations about the use of laparoscopic surgery to treat inguinal hernia – 2004
http://guidance.nice.org.uk/TA83

Laparoscopic surgery can be used as an option for repairing inguinal hernia. As with all surgery, there are some risks involved, which may include serious problems just after the operation….

In helping you make this decision you and your doctor should particularly consider:

a) how well you are likely to cope with a general anaesthetic
b) whether this is your first hernia, or whether it has come back or affects both sides of the groin
c) whether an open or keyhole operation would work best for your particular hernia
d) how much experience the surgeon has in the…techniques