Paul Goodwin was back to work Just days after laparoscopic hernia surgery.

When Paul Goodwin, a self-employed carpenter; learned he needed hernia surgery at the beginning of his busiest season, his first thought was, "How am I going to do this with all these jobs coming in?"

But when his doctor explained a new, minimally invasive surgical technique - laparoscopic hernia repair Paul began to relax. Rather than making a 3- to 5-inch incision, Paul's surgeon performed the operation through three tiny openings using special surgical instruments.

   Paul returned home from surgery the same day, caught up on some yard work the next day and installed a new bathroom just a few days later. Says Paul, who also built a brick stairway and moved furniture within two weeks after surgery, "It's unbelievable, I was really back in business in no time."
 

An innovative new technique.

   Approximately 600,000 hernia repair operations are performed annually in the United States. Traditional open hernia repair surgery means a large incision, 3 to 5 weeks of painful recuperation and an increased possibility of infection.

     Now, a laparoscopic technique makes it possible to perform this procedure in a minimally invasive manner . The patient goes home with only 3 or 4 tiny incisions, experiences minimal discomfort and, in many cases, can return to normal activity in as little as two days.

What is a hernia?

      A hernia occurs when the inside layers of the abdominal wall weaken and then bulge or tear. In the same way an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing severe pain and other potentially serious health problems.
                                   

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How do you get a hernia?

Hernias usually occur because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall.  In males, a natural weakness is created prior to birth when the testis (testicle) and spermatic cord descend through the inguinal canal from the abdominal cavity into the scrotum. In females, a ligament makes the same descent through the canal.

Is there more than one kind of hernia?

Although any part of the abdominal wall can rupture, approximately 80% of all hernias are located near the groin.  When a hernia near the groin occurs because of a natural weakness, it is called an indirect inguinal hernia. When a hernia near the groin is caused by excessive strain, it is called a direct inguinal hernia. Hernias may also be found below the groin (femoral), through the navel (umbilical), and along a previous incision (incisional).

Can anyone get a hernia?

A hernia can happen to anyone at any age. In children, an excessive natural weakness can lead to a hernia. In adults, a natural weakness or strain from heavy lifting, substantial weight gain, persistent coughing or difficulty with bowel movements or urination can cause the abdominal wall to tear.

How is traditional hernia repair performed?

A 3- to 5-inch incision is made through several layers of skin, fatty tissue and muscle to reveal the hernial sac. The incision is made on an angle just above the line where the abdomen meets the thigh.

     The most important part of the surgical repair involves removal of the hernial sac and closure of the opening in the inguinal canal. This closure is accomplished by sewing the edges of the remaining tissue together after the hernial sac is removed or by attaching a mesh patch to the outside of the abdominal wall just beneath the layer of muscle.

How is laparoscopic hernia repair performed?

     Laparoscopic hernia repair usually takes place under general anesthesia, so the patient is asleep throughout the procedure. Using a trocar (a narrow tube-like instrument), the surgeon gains access to the abdomen through the navel.            next

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A laparoscope (a tiny telescope) connected to a camera is inserted through the trocar, giving the surgeon a magnified view of the patient's internal organs on a video monitor.
 

     Two or three additional trocars are inserted to accommodate special instrumentation. The surgeon pulls the hernial sac back into the abdominal cavity and opens it to expose the defect in the abdominal wall. The defect is covered with a mesh patch that is anchored securely to the abdominal wall with an instrument called the Multi-fire Endo Hernia-stapler.

     Following the repair, the small incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible.

What are the advantages of laparoscopic hernia repair?

Laparoscopic hernia repair requires only 3 or 4 tiny openings, each 1/4 to 1/2 inch in diameter, instead of the traditional 3- to 5-inch incision. As a result, patients experience much less postoperative pain, heal faster, and many are able to resume normal activities in as little as two days compared to 3 to 5 weeks.

     In addition, with laparoscopic hernia repair, the mesh patch used to cover the abdominal defect is placed on the inside of the abdominal wall instead of the outside. This method works with the natural outward pressure of the abdomen to secure the repair and promote healing.

How soon will I go home?

Both traditional and laparoscopic hernia repair are usually performed on an outpatient basis. Patients are generally permitted to return home within 4 to 6 hours following the procedure.

Should I be concerned that this is a new procedure?

Laparoscopy has been used in gynecologic surgery for nearly three decades, and today, more than 80% of all gallbladder surgery is performed laparoscopically. More recently, general and thoracic surgeons have applied the laparoscopic technique to a broad range of surgical procedures including appendectomy, hysterectomy and lung and bowel surgery.

     It is important to remember that before undergoing any type of surgery - whether laparoscopic or traditional you should ask your surgeon about his or her training and experience.

Am I a candidate for laparoscopic hernia repair?

If you have an inguinal or femoral hernia, you may be a candidate for laparoscopic hernia repair. Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous lower abdominal surgery or who have some pre-existing medical conditions. A thorough evaluation by a qualified surgeon can determine if laparoscopic hernia repair is an appropriate procedure for you.
 

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