Laparoscopic hernia surgery is an important part of comprehensive hernia repair. By providing hernia patients the option of laparoscopic hernia surgery, some patients may have a better outcome.Patients who have large ventral hernias, recurrent hernias, bilateral inguinal hernias, and others may be a good candidate for laparoscopic hernia repair. Some patients desire laparoscopic hernia surgery to help minimize their recovery during sports seasons or when there are upcoming athletic competitions.
Laparoscopic Hernia Surgery Repair – Inguinal
A laparoscopic inguinal hernia requires a 1-2cm incision at the belly button, and two smaller punctures below the umbilicus. The belly button incision allows the camera to view the inside of the abdomen and the two smaller punctures are for the operating instruments.
To begin, a balloon is placed from the umbilicus to separate the peritoneum, or the lining of the abdomen, from the overlying muscle. Once this space is created, a camera is placed under the muscle to view the hernia.
The hernia is then pulled back into the abdomen from it’s hole in the muscle. This hole can either be lateral to the blood vessels (indirect inguinal hernia, left below) or towards the middle from the blood vessels (direct inguinal hernia, right below). Regardless, the surgery is the same; once the hole is found, a small mesh is placed under the muscle to reinforce the hernia defect.
Laparoscopic Hernia Surgery Repair Cases – Inguinal
This patient had a noticeable bulge in the left groin. He opted for laparoscopic surgery for treatment. The balloon spacemaker (see above) is placed under the muscle but over the intestines. When the balloon is removed, the hole in the muscle is found. A lightweight mesh is placed over the defect to repair the hernia. Below is a narrated video of a laparoscopic inguinal hernia repair by Dr. Harris at California Hernia Specialists.
Laparoscopic Inguinal Hernia RepairDr. Harris narrates an actual laparoscopic inguinal hernia repair done at our hernia center.
Laparoscopic Hernia Surgery Repair – Ventral/Incisional
Ventral hernias, epigastric hernias, recurrent umbilical hernias, as well as several other, are excellent candidates for laparoscopic hernia repair. Similar to the inguinal hernia, a camera is placed through the muscle into the abdomen along with two smaller punctures for the operating instruments. From there, any scar tissue between the intestine and the hernia is cut allowing complete exposure of the hole.
A hernia mesh is rolled and placed through one of the laparoscopic ports into the abdomen. From there, it is pulled up against the muscle surrounding the hernia with stitches (sutures). Once the mesh is secured in place with about 4 sutures, a special stapling device is used to further fix the mesh to the healthy muscle.
Patients should read our ‘Comparison of Open & Laparoscopic Surgery‘ page to read the pro’s and con’s of open versus laparoscopic surgery.
Laparoscopic Ventral/Incisional Hernia Repair Cases
The following two patients had incisional hernias which came back after a prior surgical repair (recurrent incisional hernias). Both were done at large university hospitals and both recurred within months after having their surgery. We treated both patients with laparoscopic surgery after discussions with the patients about their desires and expectations for after the surgery. Some patients will benefit from laparoscopic repair, while some might benefit from an open approach.
1. Laparoscopic repair of recurrent incisional hernia in a 74 year old doctor.
A 74 year old physician had a large pelvic tumor removed which was non cancerous. She developed a hernia 2 years after her surgery and underwent a laparoscopic incisional hernia repair at a large University Hospital in Southern California. Weeks after her surgery, she noticed a recurrent bulge in the lower part of her abdomen.
She presented to California Hernia Specialists for evaluation and treatment. On examination she had a 1-2 inch bulge in the lower abdomen, just above her pubic bone. This recurrent incisional hernia was painful when she exercised and while she was at work. We offered her laparoscopic recurrent incisional hernia repair.
Laparoscopic Ventral Hernia RepairDr. Harris narrates a laparoscopic incisional hernia repair.
2. Hernia in a 30 year old woman after endometriosis surgery and c-section.
This patient had several surgeries for endometriosis and c-sections. After one of her surgeries she developed pain in the lower abdomen and a bulge. The bulge would get bigger and smaller, and sometimes extend down to the right labia. She had pain with most activities including simple tasks like standing and sitting.
She had a laparoscopic hernia repair previously, but the mesh wasn’t placed low enough to cover the entire hernia defect, or the hole in the muscle. She presented to us for a second opinion and further treatment. Her small intestine was stuck in the hole at the beginning of the surgery and had to be pulled out prior to repairing the defect. A ‘tension free’ repair (see below) was performed.
Tension Free Repair
The term ‘tension free’ hernia repair is commonly used to describe hernia surgery. Hernias are caused by a weakening of the abdominal muscles. Some surgeons choose to sew the muscles back together, thus causing ‘tension’ on the muscles around the hernia. However, the muscles around a hernia are already weak, and over time those muscles tend to pull apart and the hernia can recur, or come back.
Therefore, most hernia specialists today utilize a mesh to help strengthen the muscles. When using a mesh, the muscles themselves are not sewn together (see below). Instead, a mesh is placed over or under the hole in the muscle to prevent anything from pushing through the abdominal wall.
Some patients have heard or read negative information about mesh surgery. However, the unbiased government agency The National Institutes of Health performed a study of whether mesh should or should not be used for hernia surgery. Read the article by clicking on the logo to the right:
Patients can read more on our ‘Truths About Hernia Mesh‘ page.
About Hernia MeshDr. Harris discusses the benefits of using hernia mesh and why 99% of hernia specialists use mesh during surgery.
Dr. Harris specializes in surgical repair for all hernia types. For patients who require a laparoscopic surgery, Dr. Harris commonly performs these procedures. When performing a tension free mesh hernia repair, Dr. Harris uses the latest and most advanced lightweight mesh available which significantly reduces pain and discomfort after the surgery. Many surgeons still use mesh which was invented 10 years ago which can increase the chances of post operative mesh pain.
Today’s advanced mesh reduces those risks to almost zero. Although open surgical hernia repair is still an important option for many patients, every patient should consider being seen by a surgeon who can perform advanced laparoscopic hernia surgery and who uses the newest lightweight mesh. Only a small handful of the hundreds of general surgeons in Orange County, Los Angeles, Riverside and San Diego have the experience to perform hernia surgeries using laparoscopic techniques and use cutting edge lightweight mesh.