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Laparoscopic Hernia Repair Surgery
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You May Have These Symptoms
- Bulge under the skin in the groin (inguinal), naval (umbilical) area, or sites of previous operations (incisional)
- Pain when lifting, coughing or straining while urinating or having bowel movements
- Pain may be sharp, sudden or both
- Pain may be dull
- Pain may get worse at the end of the day or when standing for long periods of time
- Severe, continuous pain with signs of redness and tenderness
[back to top]What is a Hernia and What Causes a Hernia?
You may be asked to consider undergoing a surgical procedure for a hernia. A hernia is a weakness or tear in the abdominal wall. A hernia is sometimes called a rupture. Picture an old bicycle tire. Think of the outer tire as similar to the tissue surrounding your abdominal wall (fat, muscle, and other tissue). Think of the inner tube as similar to the peritoneum (lining of your abdomen), but instead of holding air, the peritoneum holds your intestines and other important organs.
Weakened Abdominal Walls
Usually the abdominal wall is strong enough to hold these organs in place, however, sometimes a hernia may form, causing a bulge of the abdominal lining and sometimes tears. A loop of intestine or fatty tissue may push against the abdominal lining creating a sac. You may feel burning or tingling. There is no immediate danger at this point.
Intestines Pushing into a Sac
Generally a hernia forms a bulge as the intestine pushes into a sac. If the bulge flattens when you push against it or lie down, it is called a reducible hernia. There is no immediate danger and hernia repair is necessary.
Trapped Intestines
A hernia where the bulge cannot be flattened is called a nonreducible hernia. If the intestine is trapped it is called incarcerated. Often there is pain and prompt surgery is needed.
Strangulated Intestines
Intestines that become tightly trapped or strangulated lose blood supply and die. Stangulated intestines can block digestion. The pain can be severe. Immediate surgery is needed to correct the block and repair the hernia.
There are two causes of hernias: congenital and acquired. Congenital hernias are weaknesses of the abdominal wall that are present at birth. Acquired hernias are weaknesses or tears of the abdominal wall caused from wear and tear over several years. Both men and women of all ages have hernias.
Where do Hernia's Occur?
- An incisional hernia may occur anywhere on the abdomen where there is a previous surgical incision.
- An umbilical hernia may occur around the "belly button" or naval area in the umbilical ring.
- A direct inguinal hernia may occur in the groin near the area called the internal ring.
- An indirect inguinal hernia may occur in the groin located at the internal ring.
- A femoral hernia may occur just below the groin.
- Bilateral hernias may occur on both the right and left sides of people.
- A recurrent hernia may occur at a site where a previous hernia repair was done.
What are Treatment Options?
Traditional Approach
You may be given general, spinal or local anesthesia with sedation. An incision is made in the skin, fat layer, and level where the defect is located. Your surgeon may choose to use a piece of surgical mesh to repair the hole or weakened area.
Laparoscopic Hernia Repair
Your physician may recommend laparoscopic hernia repair surgery. With recent advances, the technique has been modified using a laparoscopic (advanced minimally invasive) approach that avoids the need for a large incision. There can be decreased pain in some patients. In laparoscopic inguinal hernia surgery, the patient is given general anesthesia or occasionally spinal or regional anesthesia. As many as three to four small incisions are made. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is inflated into the abdominal cavity to allow room to work and allow the surgeon to see. The defect is identified and carefully dissected and repaired. Your surgeon may perform a transabdominal (opens the peritoneum) laparoscopic repair or extraperitoneal laparoscopic repair (does not open peritoneum). Usually, a mesh is placed to cover and reinforce the weak area in the abdominal wall. The mesh acts as a patch. Mesh is secured by staples, clips or sutures and will remain permanently. Mesh or staple are not harmful to your body. At the end of the surgery, carbon dioxide gas is removed.
What can I Expect to Happen Before Having Laparoscopic Hernia Repair Surgery?
- Preoperative tests may be ordered depending upon your medical condition and the type of anesthesia planned for your surgery.
- Blood tests, electrocardiogram (EKG) or chest x-ray may be ordered depending on your age and medical condition.
- Shower/bathe the night before or morning of surgery.
- If a smoker, stop smoking to avoid straining from coughing and help promote good blood flow for wound healing.
- Patients who have difficulty moving their bowels, may have an enema or preparation ordered. Speak with your surgeon.
- Avoid heavy lifting.
- Don't eat or drink anything including water after midnight the evening before surgery. This decreases the risks of vomiting while under anesthesia.
- If taking medications daily, discuss with your physician prior to the morning of surgery the need to continue yours. Medications such as anti-inflammatory, aspirin, blood thinners, and insulin are examples of medications that may need to be decreased or temporarily stopped.
- Ask someone to drive you home after your surgery. Ask for extra help at home after surgery.
What are Expected Results After Having Laparoscopic Hernia Repair Surgery Versus Having an Open Abdominal Surgery?
- Decreased postoperative pain
- Shortened hospital stay
- More rapid return to bowel function
- More rapid return to work
- Minimally sized incisions with a better cosmetic result
What are the Risks of Having Laparoscopic Hernia Repair Surgery?
As with any surgery there are risks. The risk of one of these complications is no greater than if the surgery were done with the open technique. Complications that can occur are:
- Bleeding
- Infection involving the wound, blood or abdomen
- Injury to surrounding organs such as the bladder, intestines, blood vessels, nerves or the spermatic tube that goes to the testicles (males)
- Difficulty urinating following surgery may occur and a temporary catheter may be ordered to drain the bladder
- Numbness and pain in the groin region may require an open surgery technique
- Even though a hernia may be repaired, it may return
What Happens if Surgery Cannot be Performed by Laparoscopic Technique?
Sometimes it is not possible for the surgeon to use the laparoscopic technique because it may be difficult to see or handle tissue safely. The surgeon decides to perform an open procedure either before or during the surgery. The surgeon may decide to convert the laparoscopic surgery to an open procedure in certain situations and for patient safety. Though very infrequent, when conversion to an open technique occurs, it should not be considered a failure of the procedure. Factors that might increase the possibility of changing to an "open" procedure are obesity, previous abdominal surgery causing dense scar tissue, inability to see organs or bleeding during surgery.
What can I Expect to Happen Before Having Laparoscopic Surgery?
- A thorough medical evaluation will be made by your physician. Several diagnostic tests may be needed. You may have blood tests, an electrocardiogram (ECG or EKG) or chest x-ray to check your heart and lungs. You and your physician will discuss whether or not this surgery will help you.
- Taking no food of liquids after midnight the night before the surgery. This decreases the risk of vomiting after you receive anesthesia.
- If taking medications daily, discuss the need to take them with your doctor prior to the morning of surgery (with a sip of water). If taking blood thinners, aspirin or arthritis medications, discuss the proper time to stop these before the surgery date (day).
- Speak with the anesthesiologist before surgery to discuss anesthesia and keeping you free of pain during surgery and pain management postoperatively.
- Arrange for someone to drive you to the hospital the day of surgery and take you home when you are discharged to go home from the hospital.
What can I Expect the Day of Surgery?
- Arrive at the hospital on the day and time you are instructed.
- Sign a written consent authorizing your physician to perform surgery.
- Receive a small needle/catheter in your vein to provide medication before, during and after your surgery.
- Receive preoperative medications as necessary.
- Going to the recovery room after surgery and having your blood pressure, pulse, and respirations closely monitored until you are fully awake.
- Receive medication to relieve discomfort.
- Receive small bandages over incisions.
- Go home as soon as as you are able to eat, drink, urinate, and walk.
What can I Expect After Surgery?
- Incision sites will be tender. If ordered, the first few days after surgery, take pain medication as directed.
- You may take a shower the second day after the surgery.
- You may experience bloating or constipation.
- Days 1-2, drink fluids, and eat lightly. After that, resume your usual dietary habits. A healthy high fiber diet is encouraged.
- Lift objects that are easy to handle. Use your legs to handle most of the work. Avoid heavy lifting or strenuous activity for the first two to four weeks after the surgery.
- Walking and stair climbing are good to improve your circulation.
- Avoid driving for one to two weeks after your surgery until most of your pain is resolved and while still taking pain medication.
- Some bruising around the operative area and even extending to your genitalia is expected.
- Assume sexual intercourse as soon as you feel comfortable and have discussed this with your surgeon.
- Call and schedule a follow-up appointment within one to two weeks after surgery. Schedule any additional follow-up appointments.
- Have any stitches removed depending upon the type your physician uses.
- Discuss with your surgeon your return to an office job within days and up to two to four weeks for physically demanding jobs.
When Should I Call My Physician?
Make certain that you call your physician if you have any of the following symptoms:
- Worsening redness around the incisions
- Significant drainage from the incision sites
- Persistent fever over 101 degrees (Fahrenheit) or chills
- Persistent and/or productive cough
- Persistent nausea or vomiting
- Worsening testicular redness or pain (males)
- Prolonged soreness or no relief from prescribed pain medication
If you have any questions about the need for laparoscopic hernia repair surgery, alternatives, procedure cost, insurance or billing, physician training and experience, or have questions about surgery, you are encouraged to ask office staff or your physician.
Written by:
Horatio Asbun, M.D.
Director of Minimally Invasive Surgery Programs
John Muir Health
Jacklyn J. Schuchardt, RN, MSN, CNOR
Clinical Nurse Specialist, Surgery
John Muir Medical Center, Walnut Creek Campus
Walnut Creek, California
Diane M.Graham, RN, MSN, CNOR
Perioperative Clinical Nurse Specialist, John Muir Medical Center, Concord Campus, Concord, CA