LAPAROSCOPIC (KEYHOLE) HERNIA REPAIR

Hernias are discussed in more detail in the conditions section. They never improve without surgical intervention and typically continue to enlarge, causing discomfort and pain. In rare cases they can strangulate which is where the contents of the hernia lose their blood supply and become gangrenous. Not only is this a very painful condition it, if left untreated as an emergency, can have fatal consequences. The keyhole technique is particularly well adapted to repairing inguinal hernias and Mr Stellakis is one of the most experienced surgeons using the more advanced TEP keyhole technique in the UK.

During this procedure, Mr Michael Stellakis will use a laparoscope, a thin tube with a camera on the end, to repair the muscle wall through which the hernia is protruding. Typically 3 very small incisions are made in the abdomen.

Frequently Asked Questions

The Royal College of Surgeons, The World Health Organisation (WHO) and the generally accepted consensus internationally is that the majority of hernias should be repaired even if they are not causing symptoms such as pain. This is particularly pertinent for inguinal and femoral hernias because even if your are not fit for a general  anaesthetic they can be done under a very safe local anaesthetic if they are not too big. This is why it is important to consider early intervention as hernias if left get bigger and are then more complex to repair. There is also the risk of strangulation where the contents of the hernia become gangrenous. This obviously is very serious and can be life threatening.

Unfortunately this is a common misconception. The vast majority of hernias should be repaired and this  is particularly true for inguinal and femoral hernias. This consensus is backed up by the Royal College of Surgeons and the World Health Organisation. If your hernia is very small and not at all painful then a watch and wait approach maybe appropriate and Mr Stellakis will advise if he thinks this is the case.  The problem in the UK is that NHS funds are very limited and hernias are not considered important. Hernia surgery therefore is highly rationed by the Clinical Commissioning Groups and this is probably why you were told this.

The risks for laparoscopic hernia surgery are similar to open surgery and depend on the type and size of hernia being repaired. For Inguinal and femoral  hernias the risks are extremely low. The risks involved in any surgery include reaction to a general anaesthetic, bleeding and infection. Risks that are specific to hernia repair include recurrence of the hernia, pain and discomfort at the site of the hernia and damage to the blood vessels, nerves or nearby organs. Mr Michael Stellakis will discuss these in full during the consultation. The risk of long term chronic pain or recurrence is extremely low (less than 0.25 %) after laparoscopic repairs in Mr Stellakis’s practice.

Please refer to the specific information sheets below.

Mesh has gained some notoriety in the press recently particularly after the publication of The Cumberlege Report. That said most of the issues were with gynaecological meshes and implants and meshes deployed with the abdominal cavity. Meshes in inguinal hernia surgery have been used for almost 70 years and where there is a wealth of experience in their use. Most patients are concerned with chronic pain and this does occur in about 4% to 7% of patients but is not usually debilitating pain. It becomes even rarer over the age of 60. Chronic pain is probably as much to do with the ‘open approach’ as it is to do with the use of mesh. If you want to avoid chronic pain then a laparoscopic (keyhole) approach if appropriate is probably for you. Chronic pain is very rarely seen after a keyhole repair. Repairing hernias with out mesh may lead to higher recurrence rates. Mr Stellakis can do mesh-less repairs and often does in umbilical and femoral hernias. Mr. Stellakis will be happy to talk about meshes and their problems with you.

Pros

Laparoscopic surgery affords you a quicker post op recovery with less pain and quicker return to full function, work and driving etc. For inguinal hernias this is about 1/2 to 1/3 of the time when compared with open surgery.

Chronic pain after hernia repair is extremely rare after a laparoscopic  approach and therefore is preferred in younger, more active men

If you have a recurrent hernia then a laparoscopic approach is mandated if the original repair was open. The risk of re-recurrence if repaired laparoscopically is 1% as opposed to 20% if repaired open again. There is also a significant risk to the testicle if another open repair is done.

If you have bilateral (double sided) hernias again a laparoscopic approach is mandated as you can repair both hernias at the same time and the recovery is the same as repairing one side. It is not advisable to repair both hernias at the same time using the open method for recovery and pain reasons.

Cons

You need general anaesthetic for laparoscopic repair so may not be appropriate for elderly or frail patients.

Sometimes we may start keyhole but not be able to finish keyhole. This is called a ‘conversion to open’ and Mr Stellakis will repair your hernia via the open method. Mr.Stellakis’s conversion rate is 0.5% and this is one the lowest conversion rates int he UK.

This depends very much on what type of hernia you are having repaired and on the patient. The following is average. For laparoscopic inguinal and femoral hernias you will experience 3 to 4 days of discomfort, be back to work in 1 to 2 weeks and fully recovered at 2 weeks. For smaller umbilical and epigastric hernias performed laparoscopically recovery is about the same. Laparoscopic incisional hernias take longer sometimes 4 to 6 weeks but depends on the size of the hernia. Most patients can go home the same day and you will be advised  on post op activities my Mr Stellakis accordingly. Also see post-op instruction below.

Wound care

If dressings are used they should stay on for 48 hours. We advise just washing during this time to reduce the risk of getting the dressing wet and encouraging infection. That means no showers or baths. On day 3 you can take the dressing off and shower as normal and re-apply a new dressing if you wish. After 5 days just leave it open to the air. Avoid bathing, soaking or swimming for one week.

If cyanoacrylate glue was used as a dressing then you can forget the wounds and shower as you normally would the next day after surgery.

Bruising can occur and sometimes can be quite extensive. This is not a problem usually and although it can be somewhat alarming it will all settle in a short time.

Activities

The general rule is to stay active; walking around; going up the stairs from day one but be sensible. Your body will let you know if you are overdoing it. Each day you can do more. Avoid heavy lifting for 2 weeks. Heavy lifting is furniture, garden machinery and people! You can drive when you are able to make an emergency stop without pain. This varies but generally most people are OK to drive at about 3 to 4 days but longer if you had an incisional hernia repair.