Why is laparoscopic hernia repair most commonly performed at TheSydney Hernia Clinic ?
For many years, several differing operations including laparoscopic hernia repair were used at The Sydney Hernia Clinic. With considerable experience at The Sydney Hernia Clinic over many years and with knowledge obtained from training and research it has been found that the laparoscopic (keyhole) hernia repair using mesh gives excellent results in terms of patient comfort, safety and long term durability of the repair (recurrence rates reported by The Sydney Hernia Clinic are less than 1%.
When The Sydney Hernia Clinic came into being in the early 1990s there was controversy regarding each form of hernia repair amongst surgeons. The laparoscopic repair was particularly controversial but with experience it has been recognised as the “gold standard”.
What is a hernia?
Hernia repair is one of the most commonly performed surgical procedures. In Australia, more than 40,000 hernias are repaired annually, while an even greater number go untreated.
A hernia is the protrusion of an organ or tissue through an abnormal opening. Think of a ruptured tyre. When the tyre wall separates the inner tube can seep through the opening. Similarly when a hernia occurs tissue protrudes through the abdominal wall. As the hernia enlarges it forms a sac. Internal organs such as the intestines can fall into this sac creating one of the major hernia symptoms - a bulge.
A hernia-induced bulge is most often visible when standing. Lying down allows the tissue in the sac to return to its proper position and the bulge temporarily disappears. While hernias occur throughout the body, 95% are in the groin area.
A hernia is a weakness or defect in the abdominal wall. It may be present from birth or develop over a period of time. If the defect is large enough, abdominal contents such as the bowel, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, the umbilicus (belly button) and previous surgical incisions.
How do I get hernia?
Hernias can be present at birth or occur over time due to stress and strain on the abdominal wall. Most hernias become apparent later in life because it takes time for the hernial sac to enlarge enough for tissue to fall into it.
What are my options?
Without surgery you simply tolerate the hernia. Wearing a truss or binder may temporarily alleviate symptoms but will not cure the hernia. Only surgery corrects the defect in the belly wall.
Traditional repair techniques involve pulling together muscles and ligaments for reinforcement. Since muscles are soft and movable, while ligaments remain rigid and stationery, these structures can separate over time causing hernia recurrence. In fact, approximately 10% of hernias do recur.
Why should hernias be repaired?
Once a hernia has developed it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk most surgeons therefore recommend that hernias be repaired when diagnosed unless there are other serious medical problems.
How are hernias repaired?
The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures (stitches). Usually a prosthetic material such as nylon is used to strengthen the area of weakness. (A nylon mesh patch or plug). Finally the skin and other healthy tissues that were cut at the beginning are stitched back together to complete the repair.
How does the laparoscopic method differ?
With the laparoscopic repair the defect in the abdominal wall is repaired from the inside of the abdominal cavity. This method is usually only used for groin hernias. Instead of closing or patching the repair from the outside the patch is secured in place from the inside. This eliminates the necessity of cutting the skin and normal tissues of the groin to get down to and repair the hernia.
The use of Fibrin to fix mesh in Laparoscopic Hernia Repair
All about inguinal hernias: symptoms and causes
Inguinal hernias are protrusions of soft tissue such as a portion of the intestine through a weak spot in a muscle usually in the abdominal wall. Inguinal hernias occur where the abdomen meets the thigh in the groin region.
Anyone can have an inguinal hernia. Men, women, children and even babies of all ages experience hernias. Hernias are weaknesses or tears in the wall of the abdomen; sometimes they are referred to as ruptures. They typically occur two ways: first, by wear and tear over time (acquired hernias) and secondly from a weakness in the abdominal wall that is present at birth (congenital hernias).
Many people "live" with hernias for years before they become aware of the problem. Over time, hernias often get worse due to physical stress or aging. Children's hernias usually are congenital and are present from the time they are born.
Hernias produce different symptoms or feelings. Sometimes you will notice a protrusion in your groin area between the pubis and the top of the leg or feel pain when you strain during urination or a bowel movement, or when you lift a heavy object. The pain can be sharp and immediate. Other times you will just feel a dull aching sensation, a vague feeling of fullness, nausea or constipation; these feelings typically get worse toward the end of the day or after standing for long periods of time and may disappear when you lie down. While persons certainly can live for years with hernias without treatment they will not disappear.
If the hernia can be pushed back onto the abdominal cavity, it is referred to as a reducible hernia which while not an immediate health threat, will require surgery to disappear. If it cannot be pushed back it is non-reducible. This is a condition that may lead to dangerous complications such as the obstruction of the flow of the intestinal contents or intestinal blood supply (strangulation), leading to tissue death, intestinal obstruction produces nausea, vomiting, loss of appetite and abdominal pain and usually requires immediate surgery. A strangulated hernia is very painful and requires immediate surgery.
Over 70% of all hernias occur in the groin area between the pubis and the top of the leg known as the inguinal region of the abdomen that is why they are called inguinal hernias. Here an abnormal opening occurs in the large sac containing the internal organs, causing some of the organs to protrude. When an abnormal opening or defect occurs on both sides it is called a bilateral inguinal hernia. While most hernias are easily treated, in about one in ten people, even after treatment, they may return and need to be repaired again. These are called recurrent inguinal hernias. Recurrent hernias are not an indication of your surgeon's ability but indicate poor tissue healing or trauma to the site of the repair. Because of the development of recurrent hernias new ways to strengthen the groin are under investigation. Hence the special studies conducted at The Sydney Hernia Clinic.
What causes hernias?
Hernias are caused by congenital (defects at birth) or age-related weaknesses in the abdominal wall. In males they are caused by an improper closure of the abdominal cavity during the body's development in the womb. They can also be caused by an increase in pressure within the abdominal cavity due to heavy lifting, straining, violent coughing, obesity or pregnancy.
Signs and Symptoms
- Lump in groin area when standing/straining and disappears when reclining
- Pain at the site of the lump especially when lifting a heavy object
- Swelling of the scrotum
- Excruciating abdominal pain (if you have strangulation)
- Nausea, vomiting, loss of appetite and pain (if intestinal obstruction occurs)
Do you have any of these health problems?
It will be important for your doctor and specialist to know if you have any health problems prior to recommending surgery. In particular your doctor will wish to know from you:
- any current illnesses
- any past health problems
- any previous operations
- any medications taken
- any allergies particularly to medicines
- any breathing difficulties or anaesthetic problems
- whether or not you smoke
Over the years, surgeons at The Sydney Hernia Clinic have performed and evaluated several methods of hernia repair. All groin hernia procedures performed at Holroyd Private Hospital are subject to strict quality control. In recent years after careful evaluation of techniques available, the most commonly performed hernia procedure is laparoscopic hernia repair using polypropylene or similar mesh.
Why should I turn to specialist?
A recommendation for surgery for the treatment of an inguinal hernia should only be given after a comprehensive assessment and under strict guidelines to assure the most successful outcome. Today new advances are being made but the procedures are still being refined at The Sydney Hernia Clinic; research has been initiated to evaluate the outcome for utilising differing types of surgery for the successful treatment of inguinal hernias. With this research at The Sydney Hernia Clinic surgeons are evaluating how long the results will last, who will benefit or who will be at the highest risk for complications. The relative benefits of different operations are being assessed (See Audit – The Sydney Hernia Clinic)