What is a hernia?

The abdominal wall is composed of a flat sheet of muscle running between the ribcage and the pelvic bone. A hernia is a weakness within this muscle, usually within the groin. Through this weakness appears a 'Sac' (rather like a small balloon), which originates from the inner lining of the abdominal cavity.
Sometimes the sac is empty; sometimes it contains fat or intestines.

Why operate on a hernia?

A hernia is a mechanical weakness. No pills or exercise treatment can restore the hole within the abdominal muscle. Some hernias are uncomfortable. Given time, a hernia may enlarge or, more importantly, a piece of bowel may lie within the hernial sac causing obstruction to the bowel and the need for emergency surgery.

What type of operation is required?

A piece of synthetic nylon mesh is placed over the muscular defect. This is called a 'mesh repair'.

There are two ways of having this operation:

a) Traditional open repair
An incision is made (approximately 4-6 inches) over the groin skin and the muscles are exposed. The mesh is then sewn into the muscles.

b) Keyhole surgery
In this method three small holes are made in the abdominal wall at the level of the belly button. A camera is inserted into the abdominal cavity and the mesh is placed from within the cavity. It is held in place by several tiny titanium screws. These remain in place. They do not set off airport security alarms!

Pros and Cons of Keyhole Surgery Versus Conventional Hernia Repair

There are three small incisions in Keyhole surgery as opposed to one longer incision with traditional surgery. This means:

	The need for pain-relieving drugs is reduced.
	The return to normal activities, including driving, sport and work is more rapid
	If a hernia repair is required on both sides, these can be performed at the same time through the same three small incisions.
	Recurrent hernias are also best dealt with by keyhole methods.

Potential Disadvantages of Keyhole Surgery

A small needle is introduced into the abdominal cavity to instil carbon dioxide gas to aid exposure of the hernia. There is potential for that needle or other instruments to cause inadvertent damage to the underlying blood vessels or intestine. The risk is about 1 per 2000 cases. If inadvertent injury does occur, an incision into the abdomen may be needed to repair any injuries.

Keyhole surgery may not be recommended in some patients who have had previous abdominal surgery or have severe chest problems.

What happens if complications occur during Keyhole Surgery?

It is highly unlikely that any complications will occur but if necessary the surgeon can revert to the traditional type of hernia repair. The published trials comparing keyhole surgery to traditional hernia surgery favour keyhole surgery for several reasons:
a) Less post-operative pain
b) A quicker return to normal life
c) Less chronic testicular or groin pain post-operatively

Advice after Hernia surgery

Keyhole Surgery

Expect shoulder blade discomfort for up to 48 hours. Expect some groin ache.
There may be some bruising around the incisions or over the scrotum/lower abdominal wall.
Refrain from sport/heavy lifting for two weeks but walking is encouraged.
You may return to normal domestic activities as soon as you feel able and you may drive when you feel comfortable wearing a seatbelt and are able to perform an emergency stop safely.

Traditional Surgery

The wound may be quite swollen and uncomfortable for a number of days.
The wound may bleed a little causing swelling and bruising of the scrotum.
You may notice some numbing of sensation around the base of the penis and top of scrotum this may last for several months.

There is a very low incidence (1 per 100 000 cases) of inadvertent damage to the blood supply of the testicle, which may result in a rather small and sometimes uncomfortable testicle: in rare instances the testicle may have to be removed.

Outcome of surgery >>