Inguinal Hernia Surgery
Repair a damaged abdominal wall.
Laparoscopic inguinal hernia surgery started in the early 1990s as other laparoscopic surgeries gained a foothold in general surgery. Inguinal hernias account for three-fourth of all abdominal wall hernias. Men are at 27% risk of developing inguinal hernia at some point in their life. Meanwhile, the risk is 3% in women. Repair of inguinal hernias is one of the most commonly performed procedures around the globe. The same stands true for the United States, where approximately 800,000 inguinal surgeries are performed each year. (2)
Although open, mesh-based, tension-free repair still remains standard, laparoscopic herniorrhaphy, if done rightly by the experts, produces excellent results comparable to those of open repair. Studying the comparison between open repair and laparoscopic hernia repair, Eklund et al. found that 5 years after the operation, 1.9% of patients who had undergone laparoscopic repair experienced moderate or severe pain, compared with 3.5% of those who had undergone open repair. (1)
Plenty of studies have indicated several advantages of laparoscopic inguinal hernia repair as compared to open repair. These advantages can be: (1)
- Reduced postoperative pain
- Decreased requirement for painkillers such as narcotics
- Earlier return to work or normal routine
- Reduced postoperative pain
- Less number of inclusions
- Diminished requirement for narcotics
- Earlier return to work
- Cosmetically better
- An ideal method for people with recurrent hernias after previous surgery
When is an Inguinal Hernia Surgery Needed?
The general indications for laparoscopic inguinal hernia repair are somewhat similar to those of open repair. These general indications include symptomatic inguinal hernias causing pain and discomfort. Though the mere presence of an inguinal hernia is a sufficient indication for surgical intervention, the reducible hernia is not, in itself, an indication for surgery and that the risk of incarceration is always less than 1%. (8)
A reducible hernia is the one in which the hernial contents are back into their normal position upon the changing of position, or the patient himself can push them back.
In such types of hernia and hernias with minimal symptoms, the decision between careful watching and surgical intervention lies in the hands of a team of experts. Depending upon the individual patient and the features of the hernia, even the asymptomatic hernia may be recommended for surgical intervention in a medically fit patient. This is usually done to cut the risk of the development of an asymptomatic hernia into symptomatic one over time.
Surgical repair either by laparoscopy or by open surgery is almost always indicated with patients with strangulated or incarcerated hernia. The indications of preferring laparoscopic inguinal hernia surgery over open surgery have also been documented. Currently, studies have found that laparoscopic inguinal surgery can be a better choice than open repair in cases of:
- Recurrent hernia
- Bilateral hernias
- The need for an early return to work
The reduced pain after laparoscopic inguinal hernia surgery as compared with the open surgery makes it the procedure of choice for bilateral hernias.
Though the cost of a laparoscopic inguinal hernia may be more than that of open repair, the social benefits associated with laparoscopic surgery outweigh its cost. (8)
What is the Procedure for a Laparoscopic Inguinal Hernia Surgery?
There are three techniques of laparoscopic inguinal hernia repair. (2)
- Transabdominal preperitoneal (TAPP) Approach
- Total extraperitoneal (TEP) Approach
- Intraperitoneal Onlay mesh (IPOM) Approach
The IPOM repair has primarily fallen from favor due to the high risk of organ injury, nerve injury, and hernia recurrence. Now there are two most commonly performed laparoscopic techniques i.e. TAPP repair and TEP repair. There is also always a debate between the various aspects such as:
- The choice between the laparoscopic and open surgery
- The possible preference of one laparoscopic technique over the other one
- Socioeconomic factors and implications
Despite these debates, it is generally accepted that both the TAPP and TEP are feasible, acceptable, and safe for inguinal hernia patients.
During laparoscopic inguinal hernia repair, a patient undergoes general anesthesia, and a small cut is made just below the navel. The abdomen is then filled with air so that surgeon can see the abdominal contents, including organs, clearly.
A thin, lighted instrument called a laparoscope is inserted through the cut (incision). Other small incisions are made in the lower belly to insert the instrument. Mesh is then placed over the defect to strengthen the belly wall.
Let’s describe the difference between the two techniques of laparoscopic hernia repair from a surgeon’s technical point of view.
Transabdominal Pneumoperitoneum (TAPP) Approach
In this approach, pneumoperitoneum (air in the abdomen) is developed, and then a synthetic mesh is placed preperitoneal by dissecting the peritoneum (layer of the abdominal wall) of the hernial orifices and position in the mesh beneath the peritoneum before closing the peritoneum over the mesh.
Total extra-peritoneal (TEP) Approach
This is a preperitoneal approach in which the pre-peritoneal plan is opened by either balloon dissection or direct dissection via the paraumbilical incision. The hernial orifices can be identified and hernial sac reduced. A large mesh is placed over the hernial orifices in the preperitoneal plane.
How Much Does Inguinal Hernia Surgery Cost?
The price of inguinal hernia surgery varies depending on the technique used, geographic location, and the clinic. Below is a price list for the procedure in different countries.
| Inguinal Hernia Price Table | ||
|---|---|---|
| Country | Inguinal Hernia Surgery | Laparoscopic Inguinal Hernia Surgery |
| United States of America | $6,400 | $9,000 |
| Mexico | $3,000 | $4,500 |
Cost data estimated from information gathered by Wesley Jacobs of Apollo Medical Travel based on publicly available price information in the United States and of providers offering hemorrhoidectomy procedures in Apollo’s network of clinics.
What Are the Risks of an Inguinal Hernia Surgery?
Some People are at increased risk of developing complications after laparoscopic hernia surgery. They need special preparations. These are patients who: (4)
- have a history of clots formation in blood vessels
- smoke
- have been consuming a large dose of aspirin recently. Aspirin is a blood thinner; It can increase the risk of bleeding during the surgery.
- have been taking other blood thinner medications
- have prostate problems
The potential risk associated with laparoscopic inguinal hernia surgery are as follows: (4)
- Risks associated with general anesthesia
- Pain in the testis or the cord running from the testicle to the penis (spermatic cord)
- Injury to the testes
- Damage to the spermatic cord affecting the flow of sperms from testes to the penis: This may lead to the inability to father children
- Blood in the scrotum or belly muscles
- Infection
- Scar formation
- Numbness in the thigh area
- Recurrence of hernia: It can happen due to the mesh being too small as compared with the defect, or the mesh may not be placed well.
Conclusion
If you are suffering from inguinal hernia or any type of hernia, it is always the best idea to consult with your surgeon. Your surgeon can assess your condition thoroughly and can formulate a personalized management plan for you. Depending on your signs and symptoms, inguinal hernia surgery may be your best option.
Additional Resources
Sources
- Eklund A, Montgomery A, Bergkvist L, Rudberg C; Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97(4):600-608. doi:10.1002/bjs.6904
Read on PubMed - Krähenbühl L, Schäfer M, Feodorovici MA, Büchler MW. Laparoscopic hernia surgery: an overview. Dig Surg. 1998;15(2):158-166. doi:10.1159/000018611
Read on PubMed - Pahwa HS, Kumar A, Agarwal P, Agarwal AA. Current trends in laparoscopic groin hernia repair: A review. World J Clin Cases. 2015;3(9):789-792. doi:10.12998/wjcc.v3.i9.789
Read on PubMed - Crawford DL, Phillips EH. Laparoscopic repair and groin hernia surgery. Surg Clin North Am. 1998;78(6):1047-1062. doi:10.1016/S0039-6109(05)70368-6
Read on PubMed - Panton, O. N., & Panton, R. J. (1994). Laparoscopic hernia repair. American journal of surgery, 167(5), 535–537. https://doi.org/10.1016/0002-9610(94)90252-6
Read in the American Journal of Surgery - Ger R. Historical aspects of laparoscopic hernia repair. Semin Laparosc Surg. 1998;5(4):212-216. doi:10.1177/155335069800500402
Read on PubMed - Greenberg D, Peiser JG. Harefuah. 2001;140(7):580-679.
Read on PubMed - Salvilla SA, Thusu S, Panesar SS. Analysing the benefits of laparoscopic hernia repair compared to open repair: A meta-analysis of observational studies. J Minim Access Surg. 2012;8(4):111-117. doi:10.4103/0972-9941.103107
Read on PubMed
This article is intended for informational purposes only. It is not meant to be used as medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you have surrounding a medical condition. Never disregard professional medical advice or delay in seeking it as a result of anything you read on this Site.
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