Laparoscopic hernia repair: groin, umbilical and incisional hernias

A hernia is a bulge or lump where tissue pushes through a weak point in the muscle wall; it may grow when you cough or strain (NHS). An inguinal hernia appears where the leg joins the abdomen, and an umbilical hernia under or near the belly button.

An incisional hernia forms through the scar of an earlier operation. Up to 20% of people who have open abdominal surgery develop one, sometimes months or years later (Cleveland Clinic).

International guidelines advise surgery for groin hernias that cause symptoms. Men with no or only minor symptoms may choose watchful waiting, because their risk of an emergency is low, although most eventually need surgery (HerniaSurge).

For adults with an umbilical hernia, surgery is usually recommended because it is unlikely to get better on its own; people made very unwell by conditions such as liver disease may not be fit enough (NHS). A small incisional hernia that does not hurt may need no treatment, while large or painful ones are repaired (Cleveland Clinic). Very large or repeatedly recurring hernias may be better suited to open repair.

Laparoscopic repair uses several tiny cuts, usually three or four, instead of one larger incision (Cleveland Clinic). For groin hernias there are two main keyhole techniques:

• TAPP (transabdominal preperitoneal): the surgeon enters the abdomen, opens the inner lining over the hernia, places the mesh and closes the lining over it. During TAPP the other side should be checked for a hidden hernia (HerniaSurge).
• TEP (totally extraperitoneal): the surgeon works in the layer between the muscles and the lining without entering the abdomen. In almost all TEP repairs the mesh does not need fixing with tacks (HerniaSurge).

Both are done under general anaesthetic. A groin repair takes 30 to 90 minutes (NHS), while complex repairs can take up to five hours (Cleveland Clinic). Umbilical and incisional hernias can also be repaired by keyhole, with the mesh placed against the inside of the abdominal wall.

A mesh is a thin sheet that supports the weak area and reduces the chance of the hernia coming back (Cleveland Clinic). For groin hernias, mesh repair is the recommended first choice, by open or keyhole technique (HerniaSurge).

Not all meshes behave the same. The guidelines advise against choosing a mesh on weight alone and suggest avoiding plug repairs, which seem to have a higher rate of erosion than flat mesh (HerniaSurge). Rare long-term problems include mesh breakdown or a deep infection around it (Cleveland Clinic). A repair without mesh, such as the Shouldice technique, can be offered after discussion (HerniaSurge).

Before surgery you are examined and, in some cases, have an ultrasound, though the diagnosis can be confirmed by examination alone in the vast majority of groin hernias (HerniaSurge). Blood tests and a heart check are arranged as needed for the anaesthetic.

Bring a list of your medicines, especially blood thinners, and follow the fasting instructions you are given. Stopping smoking, controlling a chronic cough and losing excess weight are worth starting early: obesity and a long-term cough are among the factors that slow healing after abdominal surgery (Cleveland Clinic).

Most people go home the same day (NHS). Walking is encouraged from the day after surgery (Cleveland Clinic), and guidelines recommend resuming normal activities as soon as you feel comfortable (HerniaSurge). Bloating or shoulder pain after keyhole surgery usually lasts a couple of days.

Full recovery can take up to 4 to 6 weeks. The NHS advises at least 1 to 2 weeks off work, up to 6 weeks for heavy manual jobs, and avoiding heavy lifting and strenuous activity for at least 4 to 6 weeks; showering is usually fine after a few days, but wait around 2 weeks before a bath or swimming (NHS).

Complications are uncommon (NHS), but they are part of an honest decision. Short-term problems include wound infection, a collection of fluid (seroma) or blood (haematoma), injury to nearby organs or vessels, and difficulty emptying the bladder (Cleveland Clinic).

Chronic pain is the most common long-term issue: clinically significant pain affects about 10–12% of patients and decreases over time, while pain that disrupts daily life or work affects 0.5–6% (HerniaSurge). Pain lasting more than three months after surgery is called post-herniorrhaphy neuralgia (Cleveland Clinic).

Testicular complications after groin repair are low, at 0.3% to 7.2%, and about 16% of people need further surgery for a recurrence within 10 years (Cleveland Clinic).

A hernia can become trapped and lose its blood supply. Call an ambulance or go to the nearest emergency department if you have a hernia and (NHS):

• very bad tummy pain that does not go away
• nausea or vomiting, or you cannot keep food down
• a hernia more swollen than usual, with the skin over it changing colour
• you cannot pass wind or open your bowels

After surgery, contact the surgeon promptly for fever and chills, constipation or no wind, pus from the wound, a red, warm or swollen incision, or blood soaking through the dressing (Cleveland Clinic). Leg pain or swelling with breathlessness needs emergency care.

Where the expertise is available, laparo-endoscopic repair gives faster recovery and a lower risk of chronic pain than open repair (HerniaSurge). In women with groin hernias, keyhole repair is suggested to lower the chance of chronic pain and of missing a femoral hernia.

Most repairs hold. The risk of the hernia returning may be slightly higher with keyhole surgery than with open repair (Cleveland Clinic), and surgeon experience matters: guidelines estimate about 100 supervised keyhole repairs are needed to match open mesh results (HerniaSurge).

There is no single repair that suits every hernia, and guidelines recommend that surgeons offer both front and back approaches (HerniaSurge).

Whichever route you take, tell the surgeon about any previous operations, because earlier surgery in the lower abdomen can change which approach is safer.

The cost of hernia surgery in Cairo depends on the hernia type and size, one side or both, keyhole or open repair, the mesh and fixation devices used, the hospital and room class, the anaesthetic, and whether you stay overnight.

A clear written quote should list the surgeon, anaesthesia, mesh, hospital stay and follow-up visits. Dr. Yasser holds a diploma in advanced laparoscopic surgery from the European Surgical Institute in Hamburg and also performs hiatal hernia surgery and laparoscopic gallbladder removal. You can book a consultation with Dr. Yasser to have the hernia examined and receive a current quote.