Open & Laparoscopic Hernia Surgery For Hernia Repair

There are five different types of hernia, all of which are caused by different issues within the bowel. These include:

• Inguinal – the most common hernia, inguinal hernias occur when fatty tissue or part of your bowel pushes through into the top of your inner thigh (groin)

• Femoral – much less common, this type of hernia occurs when the fatty tissue of part of your bowel pushes into your groin, often passing underneath the pubic tubercle (a rounded part of your pubic bone)

• Incisional – this occurs when tissue pokes through weakened muscle or skin caused by a surgical incision

• Umbilical – when the tissue or your bowel pushes up through your abdominal wall near your navel

• Hiatal – when part of your stomach pushes up into your chest (this may not cause a lump or noticeable symptoms)

A hernia repair is an operation that’s used to repair a hole in the wall of the abdomen or groin, with the most common cause being an inguinal hernia.

An inguinal hernia repair is carried out with open hernia surgery and with an incision made to access the hernia.

As hernia repair is such a well-understood procedure by our highly experienced surgeons, inguinal hernia repair offers safe hernia repair with minimal scarring. In most cases, patients can even go home on the very same day.

Laparoscopic hernia surgery or ‘keyhole’ surgery is a minimally invasive technique that allows the hernia to be repaired without the need to open the abdominal wall.

Typically, three small incisions are made for the laparoscope (a tube with a camera on the end) and operating instruments. There are two main approaches used during the laparoscopic repair of an inguinal hernia.

Transabdominal preperitoneal (TAPP) hernia repair

A transabdominal preperitoneal repair involves accessing the hernia through the abdominal cavity. Mesh is inserted through the peritoneum (mucus that lines the abdominal cavity) and placed over all potential hernia sites in the inguinal region. The peritoneum is then closed over the mesh.

Totally extraperitoneal (TEP) hernia repair

During a totally extraperitoneal (TEP) procedure, the hernia is accessed between the layers of the abdominal wall, without entering the peritoneal cavity. TEP repair is considered to be technically more difficult than the TAPP technique, but it may reduce the risk of damage to intra-abdominal organs.

Both of these techniques are safe and are performed by our highly experienced surgeons at OneWelbeck.

Laparoscopic hernia surgery is particularly beneficial in recurrent hernias (ones which return after previous operations) or bilateral hernias (hernias on both sides). Even for standard, single-sided hernias, there are some advantages to laparoscopic hernia surgery.

Some of the main benefits include:

• Reduced pain both in the initial postoperative period and recovery – chronic groin pain occurs in around 10% of patients. This is halved during laparoscopic hernia surgery to around 3-5%.

• Minimal scarring – rather than making one incision into the groin, there are three tiny ‘keyholes’ which are barely noticeable once healed.

• Faster recovery – you can get back to daily life much quicker with a laparoscopic hernia repair.

Hernia repair is a common and safe operation, offering a high likelihood that your surgery will go well. However, as with all types of surgery, there are certain risks and potential complications that your doctor will discuss with you beforehand.

Some of these potential risks may include:

• Pain

• Bleeding

• Wound infection

• Hernia recurrence

• Haematoma – blood can collect around the site of the surgery and sometimes needs to be drained.

Before your hernia surgery, it's advised to stop smoking as this can increase your risk of a chest or wound infection. You will also need to stop eating and drinking anything except water for six hours before surgery. Then, you will need to stop drinking water two hours beforehand.

When you arrive at the centre, the nurse will check your heart rate, blood pressure and test your urine. You will be asked to put on a gown and wear compression stockings to prevent blood clots from forming in your leg veins.

Your doctor will complete the consent process with you by asking you to sign, or re-sign, the consent form. They will then discuss with you what will happen before, during and after your procedure.

Hernia repair surgery aftercare

Your wounds will be covered with a waterproof dressing you can wear in the shower for the first week of recovery. During this time, you will need to avoid activities that involve submerging yourself in water, such as bathing or swimming.

At the end of the first week, soak off the dressing in the shower and place it in the bin.

Once removed, you may see a flakey, crusty substance which is purple in colour. This is waterproof glue – don't try to remove it. Continue to only shower for another week and it will slowly come off with time.

At the 14-day mark, you can return to swimming and bathing and the wounds will be completely healed. There are no stitches to remove – these are hidden in your body and your body will dissolve them over time.

Hernia repair surgery recovery

If you have hernia repair surgery at OneWelbeck, you will go home on the same day but you will need to rest until the effects of the anaesthetic have passed (usually within a few hours). Any pain experienced after this operation will usually be mild and controllable within a day or two using over-the-counter medications like paracetamol and ibuprofen.

Your surgeon may give you a short supply of stronger painkillers when you’re discharged from the hospital along with other medicines, such as laxatives, anti-inflammatories and occasionally medicines to protect your stomach lining from the stress of surgery and the side effects of the anti-inflammatories. These will be issued with detailed instructions.

It usually takes two weeks to make a full recovery from this type of operation, but this can vary from person to person.

Things to be mindful of after hernia repair surgery

You will need to arrange for someone to escort you home due to the general anaesthesia. Try to have a friend or relative with you for the first 24 hours after your surgery. During this time, you will not be able to drive, drink alcohol, operate machinery or sign any legal documents.

Most patients need to avoid driving for up to ten days. You should be able to fly two or three days after as long as there were no complications during surgery.

You will also need to refrain from any exercise beyond normal daily activity for two weeks. This includes swimming, gym work, running or strenuous gardening. Your surgeon will review you after two or three weeks and will support a gradual return to activity. By the six-week mark, you can do whatever you wish, including high-intensity training, weight training and vigorous cardiovascular activity.

If you have a desk job or work from home, whenever you feel like you manage returning to work is up to you. If, however, you do more manual work or have to travel a lot then most people take one week off work.

Book a consultation with OneWelbeck

If you are experiencing uncomfortable hernia symptoms, contact our team to book a consultation for hernia repair.