Open / laparoscopic surgery
As laparoscopic or minimal access surgery (MAS) has developed for many operations so has it become increasingly used for groin hernia repair. In MAS hernia repair the principles are very similar to conventional open surgery utilising mesh but it is placed through much smaller incisions. All MAS is performed under general anaesthetic and once the patient is asleep the first step of the operation is the insertion of a small plastic tube through the skin in the navel into the area behind the abdominal wall. This is followed by inflation of the abdomen with gas to create a space in which to operate. It is through this ‘port’ that the camera is placed that allows the surgeon to see inside the abdomen.
Two more small tubes are then inserted through the skin below the first in the midline to allow placement of the operating instruments. The posterior aspect of the groin is then exposed and plastic mesh is placed over the hernial defect secured in place by a few metal staples. The gas is then removed and the skin closed in a similar fashion to the open technique. The advantage of the MAS approach is less pain post operatively (particularly for bilateral groin hernia repairs which may then be done as day cases) and a faster return to normal activities.
The National Institute for Clinical Excellence (NICE) now states that all patients may be offered a MAS groin hernia repair if performed by a suitably qualified surgeon. MAS repair of recurrent groin hernias is especially effective as by approaching the hernia from the back the surgeon avoids the scarring that would be encountered from the front and hence may reduce the complication rate.
