What is a hernia?

A hernia is a bulge caused by tissue pushing through the wall of muscle that’s holding it in. Due to stretching of tissues as the contents come out, it might cause pain and a bulge. If the neck of the hernia is small the contents can get obstructed (obstructed hernia) or even might lose its blood supply resulting in a strangulated hernia.

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common hernias are inguinal hernia (inner groin), incisional or ventral hernia (resulting from an incision), femoral (outer groin), umbilical hernia (belly button) etc. Because of its chance for developing symptoms and or complications like irreducible hernia or strangulated hernia, surgery is recommended. Surgery could be done by open surgery or using laparoscopic – key hole- method.

In the current day practice more and more hernia, be it inguinal, umbilical, para-umbilical  or incisional type; surgery is being done with laparoscopic method. The long term results of laparoscopic hernia repair in preventing recurrence are similar to that to open method.

Laparoscopic Hernia Repair:

 A number of studies have shown laparoscopic repair of inguinal hernias to have advantages over conventional open repair, including the following 

  • Reduced postoperative pain
  • Diminished requirement for narcotics
  • Earlier return to work

Laparoscopic repair has some disadvantages as well, including the following:

  • Increased cost
  • Lengthier operation
  • Steeper learning curve

The term laparoscopic hernia surgery can refer to any of the following techniques:

  • Totally extraperitoneal (TEP) repair
  • Transabdominal preperitoneal (TAPP) repair
  • Intraperitoneal onlay mesh (IPOM) repair
  • Laparoscopic component separation techniques like e-TEP and TAR surgeries.

Totally extraperitoneal (TEP) repair and Transabdominal preperitoneal (TAPP) repair are procedures for inguinal or groin hernias. Here the hernia sac is identified laparoscopically, contents of the sac are reduced back to the abdomen and a polypropylene mesh is deployed wide enough to cover the weak area to strengthen the area. This technique is applied for treatment of recurrent inguinal hernias as well following an open surgery very successfully. This allows quick recover after surgery as the pain is minimal after a couple of days.

Intraperitoneal onlay mesh (IPOM) repair is sued for umbilical, epigastric, para umbilical or incisonal or ventral hernias. Here a special coated or composite mesh is deployed through laparoscope and defect is repaired from within the abdomen using this mesh to achieve a wide coverage of the hernia defect.

Laparoscopic component separation techniques like e-TEP and TAR surgeries are techniques for larger hernias or recurrent complex incisonal hernias. Umbilical, epigastric or paraumbilical hernia with divarication of recti also can be effectively treatment with laparoscopic hernia repair. Here the hernia sacs are identified and muscles are separated to create a wide space in between posterior rectus sheath, transverses abdominis muscle and peritoneum and subsequently a wide prolypropylene mesh is deployed to cover the entire defect. This method is very effective for large and long standing recurrent hernias.