Hernia Surgery

So today I'm going to consent to you for your hernia operation, we've discussed this in the outpatients and we're going to go for a laparoscopic technique. As I said to you before there are two various ways of doing this, one is open and one is keyhole or laparoscopic. The reason why we've decided to go for keyhole is because you have two hernias in fact which we diagnose, one on one side which is much larger than the other side but usually with laparoscopic techniques we can do the same operation on both sides using the same incisions. The risks of doing it laparoscopically compared to open is that there are not much choose between the two, however there is a slightly increased risk of recurrence rates doing it laparoscopically than it is doing open, but the downside of doing it open is that some 5% of patients will develop chronic pain in their groin and that can be sometimes very annoying for patients, but majority of the time they don't have problems, but there's a small percentage which does cause lots of problems, so that's why we're going to go for a keyhole laparoscopic technique. There are two ways of doing it laparoscopically. We can either go into the abdomen, called the transabdominal technique, or we can go between the tissues, called the trans extraperitoneal technique, and we're going to go for a transextraperitoneal technique because that's the operation which is the least complications, damaging bowel etc and the way we're going to do this is we're going to make a small incision just below your umbilicus and then I'm going to put a balloon into the space between the lining of your bowels which are called the peritoneum and the space between that and the muscle and then we're going to blow up a balloon and then going to dissect and the reason why we do that is it dissects an area for us and then we're going to put a small port in with some gas and we're going to increase the gas till it's about 15 millimeters of mercury and that allows the space to be creative. It also allows me to put two smaller ports in, one five millimeter port just a little bit below the umbilical port and one just above your pubic bone and these are very small ports just measuring half a centimeter in length on both sides. Once we've done that we're going to use long instruments and I'll be looking at a television screen whilst I'm dissecting everything free and I'll be dissecting your hernia out. Now a hernia as we described before is a defect in the abdominal wall and sometimes in that defect there will be parts of your intestine may go through this but it's basically a sac which I will pull out from the hole in your abdominal wall. I then cover that hole with a mesh and this mesh is a polypropylene mesh which is inert, it doesn't cause any problems. The risk is that it can develop an infection so we have to be very careful when we put that mesh in that's under sterile techniques and everything that we do is under sterile techniques. We put the mesh in the right position and then we use small titanium clips just to clip it into the right position. Once we've finished off this operation and we let the gas out and then everything is all over. The risks of doing this procedure are because there's lots of structures there we need to be very careful when we do the operation that we can cause some bleeding which we have to be extremely careful not to do. That's probably the biggest complication risk of all, the second one as I mentioned before is infection and that's really the two most important complications with this procedure. We'll then finish off the operation by taking out all the ports and close the wounds with some stitches in your skin and one in the umbilical area which closes up the deep layers around your tummy button. So you have to be a bit careful for a week or two that you don't do too much heavy lifting because it's not really the operation of the groin where we repaired the hernia, it's where the operation on your tummy button is usually. So be a bit careful for about two weeks but with the laparoscopic technique you can really get back to work in about three or four days, you just have to be a bit careful and you can get back to full gym work in about three to four weeks.