Laparoscopic hernia repairs are also referred to as a keyhole hernia repair, they involve using cameras to view the surgical area and the repair happens on the inside of the abdominal wall. In open hernias the mesh is placed inside the inguinal canal on the posterior wall. In laparoscopic surgery the mesh is placed in the inside surface of the posterior wall. The area of tissue dissection and manipulation is slightly larger than in open surgery, so the difference in total recovery time for most one-sided hernias is the same. There are instances when laparoscopic repair is better suited than open repair. These are dependent on the patient and hernia, so everyone needs a bespoke solution tailored to them and their hernia(s).
First time one-sided hernias are nearly always better suited to an open local anaesthetic with sedation repair. An exception can sometimes be seen in the youngest and fittest patients where keyhole recovery to aerobic physical exercise such as running or event training can initially be faster, but the time from surgery to lifting heavier weights is the same (6-8 weeks). The incision is small but not significantly different in size to an open hernia repair.
There are some uncommon and rare complications which are not seen in open surgery. These comprise:
– Significant bleeding – The blood vessels encountered are much larger and controlling bleeding more difficult using laparoscopy. Very rarely a conversion to an open operation to control this can be required.
– Bladder injury – The bladder needs pushing away from the hernia site and can even be involved in the hernia. At laparoscopy it is therefore possible to injure the bladder requiring repair. This leads to a need for a catheter until the bladder wall is healed and can be distended by urine. In such uncommon cases a catheter is required until this point. Typically, 2 weeks.
– Bowel injury – Technically this will depend upon the approach taken to repair a hernia laparoscopically. We prefer to use an extra-peritoneal approach making bowel injury almost impossible but small tears in the peritoneum (delicate layer lining the abdominal wall and viscera) are frequent problems. They can be closed at surgery, but it remains possible for bowel to become stuck at points where the peritoneum is breached. This is very rare, but it can happen.
1. First thing to remember is that surgery requires dissection of tissue planes and causes a certain amount of tissue damage. Both need time to heal. Laparoscopic repair does not lead to an immediate return to activity.
2. You will require pain relief, and this is taken in the same way as advised in our post-surgery leaflet: Regular Paracetamol and Ibuprofen initially, with dihydrocodeine as a top when needed.
3. Bruising after laparoscopic surgery is less colourful in the groin than open surgery, but fluid still travels down to the most gravity dependant part (the scrotum) which swells and become bruised to varying degrees. Any swelling or bruising should resolve after 2 weeks.
4. Skin sensation changes are much less common and hardly occur at all. The risk of urine retention can be high, but the risk of needing a catheter to pass urine during your initial 48 hours of recovery is rare.
5. Return to activity follows the same principles as in open surgery and described in our post operation booklet. It is important to remain as mobile as you can. Bruising stabilises from 48 hours post-surgery. Keep wearing your TED stockings until easily mobile and walking around the house and garden.
6. Hernia pants are helpful in laparoscopic repairs too. They are not an effective pressure dressing though. Hernia pants help protect the healing abdominal wall and will make early mobilisation more comfortable providing support and reassurance. Wear then as long as they are helpful and when initially returning to exercise and greater activities or working away from a desk. They are still worth investing in a pair or 2.
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