Laparoscopic general surgery

Laparoscopic hernia repair – what to expect

Developed as a new surgical technique in the 1990s, minimally invasive laparoscopic hernia repair has become the preferred way of treating most types of hernia.

Patients recover quicker and their experience of surgery is better. Not all patients are suitable and your surgeon will be able to advise you what is best. If a more invasive laparoscopic procedure or an open operation is necessary they will explain.

Minimally invasive laparoscopic hernia repair

The most minimally invasive procedure involves three surgical ports in the abdomen. One port is used for the laparoscope, which is the camera that transmits moving images to a large screen in the operating theatre.

Your surgeon uses this to guide surgical instruments through the other two ports. A synthetic mesh covers the weakness in the abdominal wall and is fixed in place using stitches or screws. These are all medical grade and are therefore safe to stay inside you.

Laparoscopic repair of inguinal hernias

Surgeons use two main techniques to repair inguinal hernias laparoscopically:

Transabdominal pre-peritoneal (TAPP) repair uses the procedure described above. With mesh to cover all the sites where the intestine might break through the body’s wall.
Totally extraperitoneal (TEP) repair, was developed more recently and requires greater expertise on the part of the surgeon.

TEP versus TAPP repair

“TEP repair for inguinal hernias involves working between the skin and the peritoneal membrane, without going through to the abdominal cavity at all. Thereby reducing the risk of damage to the intestines and other organs in the abdomen. I prefer TEP repair because it carries fewer risks for the patient.”

Mr Jonathan Wilson, a specialist General and Colorectal Surgeon, offers laparoscopic hernia repair to his NHS and private patients in London.

Mr Wilson also performs laparoscopic keyhole surgery to repair incisional hernias (those related to previous abdominal scarring), femoral, epigastric and large para-umbilical hernias.

Find out more about the different types of hernia.

Advantages of minimally invasive laparoscopic hernia repair

The operation itself may be shorter, therefore requiring less anaesthetic. However, more complex laparoscopic hernia repairs can actually take longer, but still provide all the following laparoscopic advantages.
You experience less pain after surgery and you are up and about within 24 hours, sometimes sooner.
Your recovery is much faster you are back to gentle activity within days.
You have small incisions that heal well so there is very little abdominal scarring.
It can save you having two operations if you have a hernia on both sides of your abdomen, both can be repaired in the same procedure through the same small incisions.
It can be offered safely in complex cases for example in patients who have had a previous open hernia repair and it has failed, or who have a recurrence of their original hernia.

Preparing for laparoscopic hernia repair

Although this form of surgery is less traumatic than open surgery, it still requires a general anaesthetic and so some preparation is required.

Tell your surgeon if you are taking a drug such as warfarin, clopidogrel or aspirin to reduce your stroke risk. You may need to stop taking this medicine up to a week before surgery, but always follow the recommendation of your surgeon.
Don’t have anything to eat or drink from midnight the night before if your surgery is being performed in the morning. That means nothing at all when you wake up. If surgery is in the afternoon, check with your surgeon whether or not a light breakfast is allowed.
Have a shower before you come in to hospital.
Make sure that someone is available to take you home as you won’t be able to drive. If you live alone, make sure a friend or relative can stay with you for 24 hours or until you feel more comfortable being alone.

Recovering from laparoscopic hernia repair

Need more information?

Laparoscopic hernia repair for inguinal hernias Guidance from the National Institute of Clinical Excellence

You are bound to feel sore the day or two after your surgery. Over-the-counter painkillers should be enough to help you cope in most cases. For larger hernias your surgeon may provide you with slightly stronger ones for a few days. Either way, you will be able to get back to your normal daily routine faster than after conventional open surgery.

As soon as you are mobile and can urinate, you will be able to go home. For the majority of groin hernias this is likely to be on the same day as surgery.

Take it easy for a few days, but you should be back to normal doing gentle activities within a week at the most.