Keyhole Surgery for Inguinal and Femoral Hernia in Adults.
Introduction
Inguinal and femoral hernias, referred to as groin hernias, are very common. Approximately 16,000 hernia operations are performed in Victoria each year. Inguinal hernias occur in up to 10 percent of males but are much less common in females. Femoral hernias are more common in women than men but are much less common than inguinal hernias. The most serious complication of groin hernias is strangulation. This occurs when a segment of the bowel is caught in the hernia and becomes obstructed or even gangrenous – medical attention must be sought immediately. This complication is more common in femoral hernias. Hernias never cure themselves and almost always require surgery for repair.
What is a hernia?
A hernia is a protrusion of an organ or body part through the wall of a cavity in which it is normally enclosed. What this means, in the case of groin hernia, is that part of the abdominal contents, either bowel or fatty tissue, protrudes through the abdominal wall at the inguinal or femoral canal and comes out just below the skin. In males, a large hernia can descend into the scrotum. The inguinal canal is an oblique passage through the abdominal wall which, in the male, transmits the artery and vein to the testicle and the vas deferens. In the female, only the round ligament of the uterus goes through the inguinal canal and this is perhaps why inguinal hernia is less common in women. The inguinal canal is one of several weak spots in the abdominal wall where a hernia can occur.
How do I know if I have a groin hernia?
The commonest symptom of a hernia is the presence of a lump in the groin. Sometimes hernias can be painful, but small hernias may not be noticed initially by the patient and are sometimes found unexpectedly at a routine examination. Often the lump is more prominent at the end of the day, disappears when lying down and may not be apparent after a night's sleep.
What tests are available to diagnose a hernia?
For the vast majority of patients, a hernia is diagnosed by a simple physical examination from your general practitioner or specialist. In some cases ultrasound examination of the groin is used but most surgeons are sceptical of the accuracy of ultrasound examination for hernia. The results of ultrasound examination must be interpreted in conjunction with a physical examination by your general practitioner or specialist surgeon.
What causes a hernia?
Hernias which occur in childhood or adolescence are probably congenital. In adults a hernia is usually acquired. Although not well proven, it is thought that occupations involving heavy lifting or manual work increase the chance of developing a hernia. Cigarette smoking, chronic constipation, obesity, prostate disease and chronic coughing are also thought to predispose to hernia formation. In many patients none of these factors is present and the development of a hernia is thought to be related to the fact that the inguinal and femoral canals are natural areas of weakness in the body wall.
|
What is keyhole surgery for hernia? |
 |
|
Laparoscopic or keyhole surgery for hernias has evolved over the last 10 years. There have been several different ways of performing keyhole surgery for hernia, but the worldwide trend is toward the totally extra peritoneal (TEP) repair. The advantage of this method is that the peritoneum (the cavity containing the bowels) is not entered. A space is made by inflating a balloon between the lining of the peritoneal cavity and the groin muscles and inflating the space with CO2 gas to create a working space. |
 |
|
The standard (non-keyhole) operation involves a large incision in the groin (or both groins if there are hernias present on both sides), finding the hernia and patching the defect with polypropylene mesh.
In the keyhole operation a 1.5 cm (3/4 inch) incision is made just below the umbilicus (bellybutton) and two further tiny incisions are placed between the umbilicus and the pubis. No further incisions are required even if there are hernias in both groins. The hernia is identified and the defect repaired with mesh as in the open (non-keyhole) operation. |
When can I return to normal activities?
From the time you awake from the anaesthetic the repaired hernia is already stronger than a normal groin! Naturally you will be a little tender for the first few days but there are NO LIMITATIONS on activities other than common sense regarding any discomfort from the tiny wounds.
Can the hernia come back (recur)?
Recurrence rates for modern mesh hernia repairs (keyhole or non-keyhole) are very low, of the order of 1-2%.
The recurrence rates of keyhole hernia surgery are at least as low as with the non-keyhole operation and probably lower. The keyhole operation for inguinal hernia also prevents the future development of a femoral hernia which is a well recognised occurrence after the non-keyhole operation.
It is important to note that there is no evidence linking recurrence of a mesh hernia repair with physical activity either immediately after the operation or later.
What if I have already had a hernia repaired the old way and it has come back?
You are in luck! The keyhole operation is vastly superior to the non-keyhole operation for recurrent hernia. Results of keyhole surgery for recurrent hernia are just as good as if there had never been a previous operation.
Non-keyhole surgery for recurrent hernias has a significant failure rate and significant risks including damage to the nerves in the inguinal canal and damage to the artery to the testicle which can even cause the testicle to die!
Should everyone have a keyhole operation for hernia?
No. There are a number of reasons why an individual may be better off with the non-keyhole operation:
- Very large hernias may not be suitable for keyhole repair.
- Patients with previous lower abdominal surgery may not be suitable.
- Patients unable to tolerate a general anaesthetic are not suitable.
Costs
We will provide you with a full explanation of the costs of the operation to
assist you in deciding to proceed. They will vary depending on your level of
private health insurance.
The Next Step
If you decide to take the next step you will need to ask your local doctor
for a
referral to see Mr. Michael Bickford. This referral will need to include
information
on your medical history, any past and current medication you are taking and any
investigations you may have had. Once you have this referral simply contact Mr.
Michael Bickford’s consulting suites on (03)9210 7277 to make an appointment.
|
