Laparoscopic Hernia Repair  ::  Modern Hernia Repair

Laparoscopic (Telescopic) Hernia Repair

Laparoscopy - or telescopic surgery - is now well accepted as an option for a number of surgical procedures - though techniques are constantly evolving and being improved.

This issue of Small Incisions focuses on hernia repair. Compiled for General Practitioners, it aims to answer some of the questions I'm asked most frequently about laparoscopic procedures.

My initial training in laparoscopy was in Canada, the United States and Australia. I regularly attend overseas meetings to keep in touch with new developments. I welcome the opportunity to pass on this information - if, after reading this first copy of Small Incisions you'd like to discuss any issue, please don't hesitate to contact me.

There are still many surgeons who feel that laparoscopic repair of hernias is not warranted, as they feel that the results are no better than open repair. As it is a difficult operation to master, it is not surprising that reports in the literature from training hospitals report less than envious results. With well over 2000 laparoscopic repairs, (a huge series by international standards) , and minimal complication rate, there is an enviable experience at Northridge Specialists. So much so, that I do not charge for the very occasional reoccurence!

Traditional vs modern hernia repair

There are at least a dozen types of repairs for hernias. 'Modern' repairs are in fact variations of the older repairs, and the most common employ a piece of mesh - much like reinforcing concrete with some steel. The scar tissue entwines through the mesh.

Advantages of the newer method

Why use a new method, when the old style did well for so long?

The conventional repairs - open surgery - are painful with a slow return to full physical activity. The newer repairs are far more comfortable for the patient and nearly always done on a daycare basis. The return to full physical activity is rapid.

Why aren't the newer techniques used by all surgeons?

The telescopic surgery technique is difficult to learn and requires more training. Even the surgeons who initially criticised laparoscopic techniques are starting to try them now. I have been using laparoscopic (telescopic) procedures for more than five years, and while working in Australia, learned from my colleagues' expertise in the area of hernia repair.

How do the results compare?

Intial audits indicate that results appear to be better. There is no doubt that it is a less painful procedure, and the complication rate is lower. Longer term results including the recurrence rate won't be known for around a decade, as the technology is relatively new.

Is the method suitable for all patients?

Not always. There are relative advantages and disadvantages with each repair, and these are tailored to meet the needs of the individual. Only a surgeon well versed in all these repairs can give adequate advice.

Why is laparoscopy controversial?

Anything new has the potential to be controversial. While laparoscopy has long since 'come of age' and is no longer considered experimental, anecdotal accounts of the early, learning days are sometimes still used by the critics. The laparoscopic techniques are not easy and many surgeons have difficulty in adapting to operating from a two-dimensional image.

Obviously, those having difficulty will get poor results.

What about the cost?

Laparoscopic hernia repair is only slightly more expensive than open surgery. Surgeons well experienced in these techniques can keep the costs down. Because a laparoscopic hernia repair can usually be carried out on a day-stay basis, the hospital charges will be less. An important point for busy business people is that they may not have to take more than a day or two away from work, so overall the costs may be less than those for standard surgery.

Laparoscopic repair or Keyhole surgery: using 0.5-1.0cm nicks, the weak area is approached via the abdominal cavity, and buttressed on the inner layer of the muscle.

Extra Peritoneal repair is a variation on the laparoscopic repair, going between the layers of the abdominal wall, without breaching the abdominal cavity.

Lichtenstein Tension Free repair uses a conventional incision in the groin, and the weak area is buttressed with a piece of mesh on the outer side of the muscle layer

For more information please contact Northridge Specialists