- Smaller Incisions: Three to four small cuts instead of one large incision, resulting in less scarring and reduced tissue damage.
- Faster Recovery: Most individuals can return to normal activities within 1–2 weeks, compared to 4–6 weeks for open surgery.
- Reduced Post-operative Pain: Minimal tissue disruption typically leads to less pain and a reduced need for pain medication.
- Enhanced Visualisation: The laparoscopic camera offers a detailed view of the surgical area, supporting accurate repairs.
- Lower Infection Risk: Smaller incisions and limited tissue handling help minimise the risk of surgical site infections.
Laparoscopic Hernia Surgery
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Laparoscopic hernia surgery is a minimally invasive procedure to address abdominal wall defects, where internal tissues or organs push through weakened muscle layers, forming a hernia. Small incisions are made to insert a camera (laparoscope) and specialised instruments. The protruding tissue is carefully repositioned, and a synthetic mesh is placed to strengthen the area and reduce the risk of recurrence. This approach typically offers benefits such as reduced post-surgical discomfort, quicker recovery, and smaller scars compared to traditional open surgery.
Indications for Laparoscopic Hernia Surgery
Several conditions and symptoms can indicate the need for laparoscopic hernia repair. These include:
- Visible Bulge or Protrusion: A noticeable swelling or lump in the abdominal or groin area that may become more prominent during physical exertion or standing.
- Pain or Discomfort: Persistent aching or sharp pain at the hernia site, particularly during movement, lifting objects, or straining.
- Bowel Obstruction Symptoms: Nausea, vomiting, or constipation accompanied by severe abdominal pain, indicating potential intestinal compromise.
- Increasing Hernia Size: Progressive enlargement of the hernia defect, increasing the risk of complications if left untreated.
- Incarcerated Hernia: Trapped tissue within the hernia that cannot be pushed back, requiring immediate medical attention.
Benefits of Laparoscopic Hernia Surgery
Laparoscopic hernia repair provides several advantages over traditional open surgery, including:
Laparoscopic Techniques for Hernia Repair
Each laparoscopic technique is designed to address specific hernia types and patient needs. The primary approaches include:
Transabdominal Preperitoneal (TAPP) Repair
This technique involves accessing the abdominal cavity and creating a flap in the peritoneum (the thin lining covering abdominal organs). Mesh is placed between the peritoneum and the abdominal wall, secured with surgical tacks or glue. The peritoneal flap is then closed to protect the mesh and prevent exposure to abdominal organs.
Totally Extraperitoneal (TEP) Repair
TEP repair is performed entirely within the preperitoneal space, avoiding entry into the abdominal cavity. The space is created using dissection and balloon dilation, reducing the risk of internal organ injury and post-operative adhesions. The mesh is positioned completely outside the peritoneum.
Robotic-Assisted Repair
Robotic systems improve surgical accuracy with 3D visualisation and specialised instruments. The surgeon operates robotic arms from a console, following the same steps as traditional laparoscopic repair but with enhanced control. This approach is particularly beneficial for complex or recurrent hernia cases.
Surgery Preparation
Medical Assessment
Blood tests, ECG, and chest X-rays evaluate overall health status and surgical fitness. A thorough review of medical history, current medications, and any previous surgeries to identify potential complications.
Medication Adjustments
Blood thinners require cessation 5-7 days before surgery. Patients should provide a complete list of medications, including supplements and over-the-counter drugs, for adjustment as needed.
Fasting Guidelines
Refrain from eating food for at least 8 hours before surgery. Clear fluids, such as water or tea without milk, may be allowed up to 2 hours before the procedure, following specific instructions provided beforehand.
Step-by-Step Procedure
Anaesthesia Administration
General anaesthesia is used to ensure the patient remains fully unconscious during the procedure. Vital signs are closely monitored, and medication levels are adjusted as necessary to maintain safety and comfort.
Creating Port Access
Three to four small incisions (ports) are made in the abdomen, allowing access for surgical instruments. Carbon dioxide gas is used to inflate the abdomen, creating space for the procedure. A camera is inserted through one port to provide visual guidance, while instruments are used through the others.
Examining the Hernia
The laparoscope is used to examine the hernia, assessing its size, location, and the condition of surrounding tissues. This evaluation helps determine the appropriate repair technique and mesh size.
Placing the Mesh
Once the area is cleared, appropriately sized mesh is positioned over the defect. It is secured in place with surgical tacks, glue, or sutures, ensuring complete coverage and reinforcement of the weakened area.
Closing the Incisions
The carbon dioxide gas is released, and the small port incisions are closed with dissolvable sutures. Adhesive strips are applied to protect the incision sites.
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Post-Surgical Care and Recovery
- Immediate Post-operative Care: Pain medication and antibiotics are provided as prescribed. Patients are typically monitored in recovery for 2–4 hours to observe vital signs and ensure safe recovery from anaesthesia. Most can return home the same day.
- Activity Guidelines: Avoid heavy lifting (over 5 kg) for 4–6 weeks. Gentle exercises and normal daily activities can usually resume within 1–2 weeks. Pain and swelling gradually decrease over the first week. Driving is generally safe after one week, provided pain medication is no longer required.
- Follow-up Care: A post-operative review is scheduled 1–2 weeks after surgery to assess wound healing and remove non-dissolving sutures, if applicable. An additional follow-up at six weeks evaluates overall recovery and readiness to resume full activities.
Potential Risks and Complications
Laparoscopic hernia surgery is generally safe but carries some risks. Infections are rare and typically respond to antibiotics. Seromas (fluid collections) near the surgical site may form but often resolve on their own. Chronic pain may develop in some cases, and rare mesh-related issues, such as migration or infection, could require the mesh to be removed. Recurrence is uncommon, and injury to nearby structures during the procedure is rare but may require immediate repair.
Frequently Asked Questions
Who is most at risk for developing hernias?
Individuals with risk factors such as heavy lifting, obesity, chronic coughing, pregnancy, previous abdominal surgeries, or a family history of hernias are more likely to develop hernias.
Can all hernias be repaired laparoscopically?
Not all hernias are suitable for laparoscopic repair. Larger or more complex hernias, as well as those with significant scar tissue from previous surgeries, may require open surgery for effective treatment.
Are there alternatives if I cannot have mesh implanted?
Mesh-free repair techniques are available but are less common. These methods may have higher recurrence rates compared to repairs using synthetic mesh, and their suitability depends on the type and size of the hernia.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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