I am able to offer conventional open hernia surgery either under local or general anaesthesia or keyhole (laparoscopic) hernia repair for inguinal, paraumbilical or incisional hernias.
- Local anaesthesia is an excellent option for those wishing to avoid general anaesthesia and is a cost-effective procedure for uninsured patients requiring inguinal, femoral and paraumbilical hernia repair (prices start from £1550 inc. for inguinal hernia).
- Almost all hernia surgery can be performed as a day case.
- Keyhole surgery does require general anaesthesia but patients do experience a quicker return to normal activity (around one week quicker in the case of inguinal hernia surgery, according to clinical trials).
- Keyhole surgery is the preferred option for recurrent and bilateral inguinal hernias and for large paraumbilical and incisional hernias due to the quicker recovery time and reduced pain.
TEP laparoscopic inguinal hernia repair
Many patients are suitable for TEP (keyhole) hernia repair. The procedure involves 3 short incisions – one just below the umbilicus and two more below that for insertion of the camera and keyhole instruments. The surgeon then identifies the weak area in the abdominal wall from the inside and repairs it using plastic mesh as used in open surgery.
Because no muscles are cut during the procedure, there is a less painful, more rapid return to normal activities such as driving, work and sport, with some patients able to drive within 3-4 days of surgery. Furthermore, there is a considerable reduction in groin numbness and pain in the months following surgery since the fragile nerves lying next to the hernia are less likely to be injured during the repair.
Clinical trials have shown that in patients with hernias in both groins obtain even more benefit because both can be repaired though the same 3 incisions. Furthermore, the operation to repair a recurrent hernia is made simpler by avoiding the scar tissue from the original operation.
Open inguinal hernia repair with mesh
This is the conventional operation for hernias and has been performed with excellent results since the early 1990s. An 8-10cm cut is made in the groin and overlying muscles to find the hernia and gently push it back into the abdomen. A piece of polypropylene mesh is then secured over the weak area with stitches to prevent the hernia from coming back.
Although good results are achieved by this technique, full recovery can take several weeks. Lifting should be avoided for 4-6 weeks and driving for at least 1-2 weeks. Furthermore, some 10% of patients develop groin pain after the surgery due to bruising or damage of small nerves under the incision. This settles in the majority but can be troublesome in around 1-2%.
Hernia surgery is very safe and only occasionally is it associated with problems or complications.
Scars: These usually heal well but their size depends upon the type of repair and size of hernia.
Conversion to open surgery: Sometimes it is not possible to successfully perform the surgery with the keyhole method. In this scenario, the surgeon will switch to standard open operation. This risk is approximately 5-10%.
Nerve injury: This is much more common after open surgery (1 in 10 patients) and results in numbness below the scar or chronic discomfort in the groin which can be permanent. With laparoscopic hernia repair it is much less (1 in 100).
Recurrence: A hernia may recur after a surgical repair. The risk is 1% for open surgery and may be slightly higher for keyhole surgery (2-3%).
Bowel or blood vessel Injury: This tends only to occur with keyhole surgery but the risk is very small risk (1 in 200). The structures at risk include the intestines and blood vessels near the groin.
|Conventional open surgery||Keyhole surgery|
|Preferable for recurrent or bilateral hernias||No||Yes|
|Size of incision||8–10cm||Three tiny incisions of 10mm, 5mm and 5mm|
|Duration of pain requiring pain killers||1–2 weeks||<1 week, if pain present|
|Return to driving and work||2–3 weeks||1–2 weeks|
|Heavy lifting||4–6 weeks||2–4 weeks|
|Chronic groin pain||10% at 3 months|
1% at 1 year