Netcare Greenacres Hospital
SASSO - South African Society for Obesity and Metabolism
Centre of Excellence

Laparoscopic surgery

Laparoscopic Inguinal Hernia Repair

Disease
An Inguinal hernia is a "weakness in the abdominal wall", usually intra-abdominal contents, pre-peritonial fat or loops of bowel, protrude through the weak spot, and is visible as a mass.

The natural progression of these hernias has been proven to be that of enlargement. The hernia becomes more symptomatic later in life due to decreased strength of musculature in the abdominal wall.

Traditionally these hernias were repaired by incision made over the groin area. The defect was then repaired either by direct suturing of the muscles or by the insertion of an artificial material called "mesh".

Recovery after open repair of an inguinal hernia traditionally would take anything from 3 to 5 weeks.

Preoperatively
Patients are carefully evaluated to determine whether minimal invasive hernia repair is the best approach for them. Once the operation is scheduled, then routine bloods and an evaluation of the patient's general health will be performed.

The patient is usually admitted to hospital on the morning of the operation and the anaesthetist will see the patient then. Because the procedure is performed under general anaesthesia, the patient cannot eat or drink anything after 10pm the previous night.

Procedure
Minimal invasive surgery for hernia repair begins with the insertions of three "trocars" (narrow tube-like devices). One of these devices will admit the laparoscope, which is a telescopic video camera, and provides a magnified view of the internal anatomical structures. The other two trocars are used to insert surgical instruments for the manipulation of the internal organs.

Dr van Niekerk watches on a video monitor as he manipulates these instruments inside the abdomen. Once the hernia is reduced, an artificial material called "mesh", will be inserted to prevent the intra abdominal contents to protrude through the "hernia" in the abdominal wall. After the operation is done, the trocars are removed from the abdominal wall and the three small, 1cm incisions will be closed with skin clips.

Post Operatively
Because of the use of minimal invasive surgery, post operative pain is minimal and most patients are able to be discharged from hospital on the same day or the next morning. Patients are able to resume normal activity within ten days of the procedure.

Physical exercise and strenuous activity are best avoided in the first SIX WEEKS post operatively, in order to give the "mesh" enough time to incorporate in the surrounding tissue.

Because a laparoscopic hernia repair is stronger than repair performed traditionally, the hernia is less likely to recur.

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