Port LapSurgery - Patient information
Hernia
LAPAROSCOPIC INGUINAL HERNIA REPAIR IS THE NEW “GOLD STANDARD”.
Dr George Petrou MBBS, BSC (med), FRACS, specialises in minimally invasive hernia repair for inguinal (TEP), ventral, incisional and hiatal hernia.
Dr Petrou highlights the Laparoscopic Inguinal Hernia Repair procedure he routinely performs at the Port Macquarie Private Hospital.
Spontaneous abdominal wall hernias in our community affect as high as 10% of the population. 80% of these are represented by inguinal hernias. The majority occur in active male patients. Repair is necessary to avoid future complications and restore normal physical function. With the widespread acceptance of “prosthetic meshes” and the “tension free concept”, inguinal hernia recurrence is now very uncommon and quoted as low as 0.1%.
The advantage of a pre-peritoneal (otherwise known as extra-peritoneal) hernia repair is that a large prosthetic mesh can be placed to cover all possible groin hernia defects (direct, indirect and femoral) using no tension. The intra-abdominal pressure keeps the mesh in place so therefore fixation with tacks or sutures is not always required. The inguinal canal and its contents are not opened and distorted; therefore far less pain is experienced.
With current advances in technology, a tension free pre-peritoneal mesh repair can now be performed through very small incisions using video assisted surgery or laparoscopic surgery. The 2 operations commonly performed are trans-abdominal pre-peritoneal mesh repair (TAPP) or total endoscopic extra-peritoneal mesh repair (TEP). I prefer to use a TEP when possible as you avoid entering the abdominal cavity and therefore the risks of visceral injury and mesh attaching and eroding into the bowel is much lower. I do perform a TAPP in select patients.
undefined
undefined
undefined
undefined
There are now many randomized controlled trials and systematic reviews (1) comparing open mesh repair with laparoscopic inguinal hernia repair (TAPP and/or TEP). There is no difference between laparoscopic and open mesh hernia repair with respect to recurrence rates. The advantages of a laparoscopic repair are significantly different in patients with bilateral inguinal hernia and recurrent inguinal hernia. These patients have far less pain, fewer complications and a quicker recovery if they have a laparoscopic mesh repair (TEP or TAPP). There is also emerging evidence that patients who have a unilateral laparoscopic inguinal hernia repair are less likely to suffer chronic pain, which can be a great hindrance to work, and quality of life after surgery (2).
KEY PATIENT BENEFITS
Reduced acute & chronic pain
Day surgery
Early return to work and lifestyle
Low rate of recurrence
Cost effective for your patients
Evidence
1.Laparoscopic techniques versus open techniques for repair of hernia in the groin. Collaboration the EU Hernia Trialist. Cochrane Summaries. Oct 8, 2008.
2.Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Kumar et al. Surgical Endoscopy (26: 1304-1317). 2012.
Hernia Repair
A hernia is a defect in the abdominal wall. The abdominal wall consists of layers of connective tissue, muscle and fat. When there is a defect, in the abdominal wall, organs inside the abdominal cavity protrude through it. This is what causes the unsightly bulge, discomfort and pain with activity. The cause of hernias is multifactorial, which means they are due to a variety of reasons, which include tissue strength, age, obesity and previous surgery. All hernias increase in size with time and become a real nuisance as they inhibit the person’s ability to work and play. In some people, the hernia contents can become stuck in the defect. This is an extremely painful and dangerous condition called strangulation which needs emergency surgery. Unfortunately the results of emergency surgery are not as good as when it is completed electively for this condition.
Dr Petrou provides a minimally invasive approach using endoscopic and laparoscopic surgical techniques for the treatment of groin hernias and large abdominal wall hernias (ventral and incisional). The benefits of laparoscopic surgery are far less post operative pain and faster recovery to normal activity. There is also clear evidence proving a laparoscopic repair to be far superior in the treatment of recurrent and bilateral (both sides) groin hernias. Evidence is now emerging, that the use of laparoscopic surgery and light weight meshes, results in far less chronic pain which is a significant long-term complaint after any hernia operation.
Dr Petrou provides total endoscopic groin hernia repair via small incision, as a day surgical procedure at the Port Macquarie Private Hospital and the Kempsey Hospital.
Information is general only and does not replace advice from your treating clinician. Contact the practice for current details.