Abdominal wall hernias are very common and generally require surgical repair, to treat symptoms (pain/discomfort) or to prevent complications. A hernia represents a defect in the abdominal wall, allowing normal abdominal contents (bowel, fat) to protrude through this defect. If the contents of the hernia become stuck (incarcerated) the tissues can swell and lead to such surgical emergencies as bowel obstruction or strangulation (blood supply compromised, sometimes resulting in tissue gangrene).
It is certainly preferable to repair hernias before such complications arise. Hernia repair is usually accomplished with the use of prosthetic mesh which strengthens the repair and greatly reduces the likelihood of hernia recurrence. Most hernias are described according to their position e.g., groin hernia (inguinal/femoral), around the belly button (umbilical, paraumbilical) or above this (epigastric). The other group of hernias that surgeons may treat are hernias through an old surgical site (an incisional hernia).
The majority of groin hernias are inguinal in nature (protrude through an anatomical structure called the inguinal canal). A small percentage protrude through a separate defect (femoral hernia) but the differentiation is largely academic, as the operation to repair both is exactly the same.
Laparoscopic Groin Hernia Repair
The laparoscopic (keyhole) approach to repair a groin hernia has been Dr Andrew Russell’s preferred approach since the mid-1990s. It is especially advantageous if people have hernias on the left and the right, or if they have a recurrent hernia after a previous open surgery repair.
It involves a few small incisions and placing and securing a piece of mesh in the appropriate position. It usually requires a one-night stay in hospital and Dr Andrew Russell asks patients to avoid any heavy physical lifting or straining for about two weeks. The chances of getting a recurrent hernia are less than 1%, with the majority of patients getting a good long-lasting repair. Dr Andrew Russell generally recommends patients plan on 2-3 weeks off work, depending on the physicality of their job. Not all patients however are suitable for the keyhole approach. Patients who are possibly unsuitable for this approach include:
- Multiple previous open lower abdominal surgeries, as adhesions may make the approach unsafe.
- Previous radical prostatectomy – due to the risk of bladder injury, Dr Andrew Russell favours an open, mesh repair.
- Recurrent hernia after previous keyhole approach. This is extremely rare (we are yet to see one), but would favour an open mesh repair.
Umbilical & Paraumbilical Hernia
Dr Andrew Russell usually favors an open, mesh reinforced repair and patients usually stay in hospital for 1-2 days. Patients are advised to avoid heavy physical work for six weeks after surgery.
Dr Andrew Russell’s usual approach to these hernias is the same as for umbilical hernia. An open, mesh reinforced repair, with 1-2 days in hospital and similar recuperation time.
An incisional hernia is a hernia that occurs after previous surgery. They tend to get slowly bigger over time and can be a single defect, or sometimes there may be multiple defects (multiloculated). They can be small, but sometimes can be very large. Surgical repair can be conducted in a number of ways. An open mesh reinforced repair is entirely acceptable for relatively small, uncomplicated hernias. For larger defects and some multiloculated defects, a laparoscopic (keyhole) approach may be possible, and give a very good chance of a longstanding repair. Mesh has been produced specifically for this sort of repair (dual sided composite mesh). The advantages of the keyhole approach are:
- Less painful recovery.
- Less risk of mesh infection.
- Better chance of long-standing repair due to accurate demarcation of defect size and position.
Some very large complicated hernias may require placement of large pieces of mesh using a technique called component separation. Dr Andrew Russell has not learnt or practiced this form of repair so would probably defer to his more experienced colleague who have special interest in this form of surgery (usually refer to Brisbane).