Bilateral groin hernia Repair
Bilateral Groin Hernia Repair
Bilateral groin hernia repair is one instance when a laparoscopic repair may confer benefit. Compared to performing open bilateral hernia repair on the same day the recovery is much quicker if performed keyhole. However, it is still a painful operation with a much slower recovery compared to a one-sided repair using either laparoscopy or an open repair technique. In most patients with bilateral hernias one is much more symptomatic than the other. Laparoscopy though can only really be done once and repairing both the same time is a good decision if you want both sides repaired. The chances of a non-symptomatic side becoming symptomatic and wanting a repair is about 80% over 12-18 months. Many prefer to have a single recovery of 8 weeks rather than 2 lots of 8-week recovery periods in such as short space of time. Very large hernias are more difficult to repair keyhole and small hernias simpler to repair keyhole. As BMI increases laparoscopy also becomes less successful. If your BMI is >28 open repair is often more comfortable.
Pioneering hernia repair for all
An alternative to a single bilateral laparoscopic repair in older, frailer patients or patients with significant urine flow symptoms or certain health problems and medication is to perform a staged open hernia repair under local anaesthetic and sedation. In this instance the repairs are done 2-4 weeks apart. The total recovery time when done 2 weeks apart is similar to a single bilateral laparoscopic repair except in the youngest and fittest patients. It is much more painful to mobilize after same day bilateral surgery as the action of hip flexion and extension whilst weight bearing (think getting up out of or down into a chair or up and down stairs or into and out of bed) is more difficult as you cannot use one side to compensate and take the weight off the sore repaired side.
In many, a staged repair has a lot of benefits. In some there is no benefit and a single operation to do both at the same time laparoscopically is the most time efficient in terms of recovery and comfort.
So, deciding how to treat and whether to treat both hernias is complex and requires a consultation with an experienced hernia surgeon to help you make an informed decision about your options.
Recurrent hernia surgery Repair
Another time when laparoscopic repair might be preferable is if you have had a previous open inguinal hernia repair the same side. In this instance using the surgical approach that was not used the first time is better in most. Particularly if that repair was after the year 2000. It is since then that meshes have been used routinely to repair hernias. Using the same approach to a previous mesh repair can be more difficult.
A previous open mesh repair that recurs is better repaired laparoscopically and vice versa.
Older open repairs done without mesh are much easier to redo using an open repair the second time. Given these tend to be seen in older frailer more co-morbid patients, a repeat open repair is safer and can be just as effective as a laparoscopic recurrent hernia repair.
Lastly, a recurrent open hernia repair can be redone using an open approach but placing the mesh in the same tissue plane as a laparoscopic repair. This avoids general anaesthetic and the risks of GA laparoscopic surgery in those less suited to that approach but allows us to do the trickier part of the operation in a fresh plane of tissues. It is a good option well suited to the older patient, but laparoscopic repair is also a great option in recurrent open hernias with no reasons not to do a laparoscopic repair.
BOOK A CONSULTATION
The decision making is guided by the patient and a consultation with an experienced hernia surgeon will allow you to make a properly informed decision about how your repair is carried out.