1. Laparoscopic Hernia Repair
Gordon Buchanan
Consultant Colorectal, Laparoscopic and General Surgeon

2. Background Colorectal Surgery – Lap and Open
General and Emergency Surgery
Lap Appendicectomy
Lap Cholecystectomy
Hernia – why not lap?

3. What is possible ? Laparoscopic Inguinal Hernia
Laparoscopic Femoral Hernia
Laparoscopic Umbilical Hernia
Laparoscopic Ventral Hernia
Laparoscopic Incisional Hernia

4. Advantages Less Pain Smaller scars Lower Wound infection
Faster Return to activity
Several hernias fixed through same incisions

5. Cautions Relative Absolute Complex abdominal surgery
Previous preperitoneal surgery
Irreducible hernia (especially left side)
Absolute
Inability to tolerate general anesthesia.

7. NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE Laparoscopic surgery for inguinal hernia repair 1.1 Laparoscopic surgery is recommended as one of the treatment options for the repair of inguinal hernia To enable patients to choose between open laparoscopic - transabdominal preperitoneal [TAPP] totally extraperitoneal [TEP], fully informed of all risks and benefits associated with each of the three procedures.

8. TEP Developing a plane

12. Increase Laparoscopic Inguinal Hernia Repair

14. Risks Risks of any operation (anaesthetic, DVT etc) Risks specific to inguinal hernia repair: Immediate: Bleeding at the time of surgery Damage to the testicular vessels or other structures (rare) Early: Haematoma in wound or scrotum Infection of the wound (<5%), Retention of urine.

15. Late: Recurrence: <5% life time risk. Damage to nerves
Normal to expect some numbness below scar as cutaneous nerves are divided gaining access to the inguinal canal.
Ongoing groin pain 3-5% - damage or entrapment of ilioinguinal nerve

16. Post op Daycase / 1 night No restrictions Driving 24hrs
Exercise – as comfort allows
Return to work 4 days
Heavy lifting as they wish
Sex – Encouraged

17. Incisional Hernia Laparoscopy New meshes against bowel Smaller scars
Less wound infection
Size of defect

18. Summary Laparoscopic Repair Most types hernia Quicker recovery
Caution in complex abdomen
Less pain