A hernia is a common condition that can affect people of all ages. It is caused by a weakness in the abdominal wall, and when the patient coughs or strains a lump may appear. Patients often present with a small reducible lump in the groin, which can be tender. Surgery under regional, local or general anaesthesia is usually straightforward. A plastic mesh is often used to strengthen the repair. This open lattice work of plastic is rapidly incorporated into the tissues increasing the strength of the repair. Return to normal activities is usually rapid. It is usual to advise repairing the hernia before it strangulates or becomes irreducible

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Before hernia repair		After mesh hernia repair
Mesh in Place		Hernia Mesh

Laparoscopic Hernia Repair
 

In the past, most hernia have been repaired using an 'open' approach: a 5-8cms cut is made in the groin and a mesh repair completed. An alternative approach, is to perform a laparoscopic hernia repair. This involves three very small cuts (1 x 1cm, and 2 x 5mm) close to the umbilicus (tummy button). The operation is performed using a laparoscope (keyhole telescope) from the inside of the abdomen. The hernia is confirmed and the sac reduced. A mesh is then is then tacked over the hernial orifice, so repairing the hernia from the inside. The laparoscopic approach has the advantage of an earlier return to normal activities and is particularly good for bilateral hernias (both sides) and recurrent hernias. The disadvantage is the patient has to be put to sleep and the recurrence rate may be slightly higher that the conventional appraoch in some situations.

 

Further information on hernias: BUPA info sheet:

 http://hcd2.bupa.co.uk/fact_sheets/html/inguinal_hernia.html

Sportsmans Hernia

A sportsmans hernia is an important alternative cause of pain in the groin in active individuals. There is a potential weakness in the abdominal wall where a hernia would normally appear. The area affected is tender but a lump is not usually felt. Surgical repair usually gives excellent relief from the symptoms and return to normal sporting activities is fast.

Laparoscopic incisional hernia repair

Hernia can sometimes develop at the site of previous sugery. Conventional surgery involves re-opening the old incision and repairing the defect. Laparoscopic repair (or a repair from the inside) is sometimes possible, a mesh being placed from the inside to repair the defect. The return to eating and drinking is faster, as is the return to normal activities. The long term recurrence rates have yet to  be determined. 


Laparoscopic Cholecystectomy

The gallbladder lies just under the liver and normally collects bile. When food is eaten (particularly fatty foods) the gall bladder contracts. When the gallbladder contains stones this contraction can be painful. Occasionally the gallbladder gets infected (cholecystitis) and this also causes pain. The gallstones are usually diagnosed by ultrasound examination.

Gallstones can cause symptoms that are sufficiently bad for the patient to want to consider a surgical procedure to remove the gall bladder. This is usually performed with telescopes (laparoscopically), and can often be done either as a day case or with an overnight stay. Four access ports (2 X 10mm and 2 X 5mm) are used to insert the instruments. The gall bladder, the cystic duct and the cystic artery are carefully identified. The artery and duct is clamped with metal clips and then cut. The gallbladder is removed usually using a ‘retrieval bag’. A drain may be used. Return to normal activities is rapid.

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		Laparoscopic Equipment

Open and Laparoscopic Splenectomy

Occasionally it is necessary to remove an abnormal spleen in a patient with a haematological condition. Sometimes a laparoscopic approach is possible.

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		A Grossly-Enlarged Spleen

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