Most hernia repair procedures conducted today use laparoscopic (minimally invasive) techniques. This involves the insertion of miniaturised surgical instruments via 3 to 4 small incisions to the abdomen (referred to as 'ports').
All hernia repair procedures are carried out under general anaesthetic. The exact techniques differ slightly depending on the type of hernia being treated.
Inguinal or femoral hernias
Both inguinal and femoral hernias can be repaired using a traditional open or laparoscopic technique. Most hernias nowadays are amendable to a keyhole approach, unless they are strangulated or very large.
With a traditional open technique, a cut is made in the groin, the hernia contents are returned to the abdominal cavity, and the hernia hole is repaired with non-absorbable mesh placed within the abdominal muscles.
With a keyhole technique, three small incisions are made to the abdomen and the space underneath the abdominal muscles is inflated using carbon dioxide gas. The hernia contents are returned to the abdomen and a non dissolving mesh is placed underneath the abdominal wall muscles. The mesh is held in place with special absorbable medical tacks.
All incisions are closed using dissolving sutures.
The majority of umbilical hernias are repaired using an open technique, rather than keyhole. A small incision is made near the navel and the protruding herniated tissue ('hernial sac') is returned back into the abdominal cavity. If the hernia hole is large enough to permit a mesh to be inserted, this mesh is usually placed underneath the abdominal muscles. If the hernia hole is very small, it is simply repaired with stitches. All incisions are closed with dissolving sutures.
Incisional hernias can be repaired using a traditional open or keyhole technique. If scar tissue (or adhesions) from previous operations permit, a keyhole technique is used. Four to five small incisions are made in the abdomen. The contents of the hernia are returned to the abdominal cavity and the hernia hole is closed and reinforced with a non-dissolving mesh placed within the abdominal cavity. This mesh has a special coating to prevent the bowel from adhering to it. If an open technique is used, the same principles are utilized however a cut on the abdomen along the previous scar is made and the mesh is placed outside the abdominal muscles.
The risks of hernia surgery depend on the type of hernia being repaired, and the technique used. The main risks however include:
- Hernia recurrence.
- Wound infections.