Inguinal hernia surgery is one of the most common general surgery procedures performed in the United States.  Every year approximately 600,000 hernias are done in this country.  Some of these repairs are done open and others laparoscopic. In this post I will help you determine if a laparoscopic inguinal hernia repair is right for you.

What is an Inguinal Hernia:

An Inguinal hernia is a weakness or a hole in the abdominal wall that allows content from inside the abdomen to protrude and cause a bulge.  They can present either in male or female patients, but they tend to be more prevalent on males.

In many instances, the bulge is visible or causes significant pain.  Many inguinal hernias are also completely asymptomatic. Some patients don’t even know they have an inguinal hernia until the go for a routine physical exam.

Inguinal hernias don’t go away spontaneously.  They tend to get larger over time and they are usually more symptomatic as they start to grow.

Symptoms of Inguinal Hernias:

Most patients complain of groin pain or testicular pain.  The discomfort tends to be worst late in the day, after walking or standing for long periods of time.  Heavy lifting, coughing or other strenuous physical activities can also precipitate the symptoms.

Most hernias are reducible, meaning that the bulge goes in and out without difficulty.  This is especially true when the patient lays down.

If the hernia doesn’t reduce, the inguinal hernia is said to be incarcerated.  If the blood flow to the organ or structure incarcerated in the hernia gets compromise then the hernia is called a strangulated hernia.

Strangulated inguinal hernias need emergency surgery.  Most strangulated inguinal hernias are not a good candidate for a laparoscopic inguinal hernia repair. An open approach is usually a better option. More on this later on this post.

Luckily, only approximately 2% of all hernias present with signs of strangulation.

Do I Need Any Imaging for Diagnosis:

Inguinal hernias are mainly diagnosed by physical exam alone. An experienced General Surgeon or primary care provider should be able to identify or diagnose an inguinal hernia in most cases.

Certain cases will require further testing.  Some care providers will order an ultrasound to ruled out testicular cancer or hydroceles.

A CT scan is usually a better tool for diagnosing difficult cases.  If the patient is significantly overweight, the physical examination could be difficult or not reliable and this imaging modality could confirm the diagnosis.

An MRI is usually helpful in diagnosing sports hernias. Sports hernias are a different entity than inguinal hernias and the usually present on high-performance athletes.  At the University of Florida in Gainesville, we did a large number of sports hernias and most of them came from the athletic program.

Imaging can be helpful but most hernias can be diagnosed with good old fashion history and physical examination.

Is Surgery Needed Right Away:

Many patients come to my office thinking that they need surgery right away. The timing of inguinal hernia repair really depends on the symptoms, presentation, complexity and surgeon availability.

As mentioned above only a minority of the hernias present strangulated or incarcerated.  Most hernias will be repaired electively.

In determining when to schedule the hernia repair the patient should take into consideration time out of work, school or vacation.  We will talk about the post-op period later on the post.

Is a Laparoscopic Inguinal Hernia Repair the Ideal Approach for Your Hernia???

I consider myself a great hernia surgeon, especially when performing laparoscopic inguinal hernia repairs. If I had an inguinal hernia and I could fix it myself, I would. But not every inguinal hernia should or can be repaired laparoscopically.

I take into consideration the patient’s age.  If you are 80 years old, with a history of respiratory and cardiac issues an open hernia repair under minimal anesthesia is the way to go.

For a laparoscopic inguinal hernia surgery, the patient needs general anesthesia and not every patient is physically fit to tolerate it.

The size of the hernia is another important factor. I have repaired several inguinal hernias the size of a large watermelon.  Trust me If I tell you that an open repair will be the best option.

Recurrent inguinal hernias or bilateral inguinal hernias are usually better repaired laparoscopically. Younger patients or physically active patients in good health are great candidates for a laparoscopic repair.

Another important factor is previous lower abdominal surgeries.  Male patients that have undergone prostate surgery are not candidates for a laparoscopic inguinal hernia repair.  Prior abdominal hysterectomy or C-sections on females are also relative contraindications.  The scar tissue in this area will make the dissection significantly more difficult.

Transvaginal hysterectomies shouldn’t present any issues.

If you have prior lower abdominal surgery make sure to inform your surgeon.

I Heard Really Bad Things About Mesh:

A good amount of patients that I see in my office have concerns about hernia mesh and possible complications from mesh placement. You have probably seen television commercials about mesh recalls or lawyers asking for unfortunate patients to call the office to receive compensation.

I will tell you that hernia mesh research and industry efforts have significantly changed this area in medicine. Synthetic Hernia Mesh currently is more lightweight, has more ergonomic designs and many other properties to improve outcomes and patient comfort.

If I had a hernia and it needed repair, It will be repaired with a mesh.

I use a polypropylene mesh made by BARD that is specially designed for laparoscopic inguinal hernia repair.

So How is a Laparoscopic Inguinal Hernia Repair Done?

Two main laparoscopic techniques are available.  The TEP (Extraperitoneal) or TAPP (Transabdominal). This is beyond the scope of this post but my preferred method is the extraperitoneal approach. Some surgeons also advertise the Robotic Inguinal Hernia Approach.  I am trained to do any of these methods but in my opinion, the TEP is easier, faster, less painful and cheaper.

Your surgeon might be more comfortable doing one of the other approaches, that is fine. What you really want and should care about is that the surgeon is well experienced in this surgery.  Studies have shown that surgeons with more experience in complex laparoscopic cases have better outcomes and lower recurrence rates.

Ask and shop around before committing to surgery.

In general, only three incisions are needed, one 12 mm and two 5 mm in size. Using a camera, TV screen and some special instruments the muscles are dissected and the hernia is reduced.  A mesh is then placed to cover the defect and prevent herniation. The mesh is usually fixated in place with tacks, glue or peritoneum.

The surgery takes anywhere between 30 minutes to 60 minutes depending on the size or if the hernia is a recurrent or bilateral hernia.

What About After Surgery:

A laparoscopic inguinal hernia repair is usually an ambulatory procedure.  Most patients will need 1-2 weeks to return to work depending on the type of work (mainly office work).  If you do heavy labor like construction, lifting or any physically demanding work approximately 4-6 weeks will be needed to fully recover.

The first 24-48 hours are the worst in terms of pain and discomfort.  A prescription for pain medication will be given. Take it, you will need it.

Some bruising and swelling are expected. Sometimes the testicles can get black, don’t panic this will resolve on its own.  They will not fall off.

Older male patients could develop difficulty urinating shortly after surgery.  A combination of factors is usually accountable.  Anesthesia, pain, dissection during surgery or prostate enlargement.  Usually, this resolves on its own, but certain patients will need to go home with a urinary catheter for 24-48 hours.

Most of my patients will return to the office for follow up 2-3 weeks after surgery. You will be encouraged to call the office if any issues or concerns developed before your appointment.

Can Anything Go Wrong:

Laparoscopic inguinal hernia repair surgery is very commonly performed and is relatively safe. The chances of having a bad complication are low, but things could happen. After all, it is an operation.  Many important structures are found in this area.

The main vessels that go to the leg or the structures that go to the testicle are present in the surgical field.  Injury to these structures could happen at any time.

Also, injury to any of the intraabdominal organs is a possibility, but again the percentage is less than 5 percent.

Many patients worried about mesh complications, as I mentioned before the mesh is very well tolerated by most.  Approximately 2 percent of all hernias will develop some chronic pain.  The chronic pain could be related to the mesh, sutures or just the dissection.  The pain could be a mild one that only presents when doing a particular movement versus a pain that is there all the time and never goes away.

Call Your Surgeon if Any Post Op:

• Fever
• Severe abdominal pain
• Vomiting
• Inability to void (urinate) as described above
• Palpitations, chest pain or shortness of breath
• Signs of infection or bleeding

Why Dr. Caban for Your Laparoscopic Inguinal Hernia Repair?

First of all, I want to thank you for reading all the way to here. I hope this post has been informative and has helped you understand if you are a candidate for a laparoscopic inguinal hernia repair.

So, why me for your hernia repair? In the Ocala, Gainesville, The Villages and North Central Florida area no other surgeon has more experience and better technical skills to repair inguinal hernias than me.  I have done hundreds of hernia repairs including giant inguinal hernias on sick patients to small hernias on healthy young patients.

Call our office today, I will be happy to evaluate your hernia and formulate a plan that is right for you.

Remember when it comes to hernia repairs experience and skills matter.

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(352) 291-0239