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Laparoscopic hernia surgery repairs a defect or weakness in the abdominal wall from the inside through three small incisions, returning the hernia contents to their proper place and covering the defect with a surgical mesh that is fixed in place to reinforce the wall. It is used for several types of hernia: inguinal in the upper thigh, umbilical around the navel, incisional at the site of a previous operation, and hiatal hernia at the top of the stomach. A hernia is the protrusion of fatty tissue or a portion of bowel through a weak point in the abdominal wall. A bulge appears that enlarges on standing, coughing and lifting and shrinks or reduces on lying down, with dragging, heaviness or pain that worsens later in the day. A hernia does not heal by itself and does not shrink with exercise, and it tends to enlarge over time, which is why surgical repair remains the only treatment. The advantage of the laparoscopic approach is that the mesh is placed inside the abdominal wall so it covers all the weak areas, and that pain afterwards is less and return to work faster than with open surgery. It is particularly useful for bilateral inguinal hernias and for a hernia that has recurred after previous open repair. It is not the best choice for everyone, however: it requires general anaesthesia, and open surgery may be better for a very large or incarcerated hernia, where there are adhesions from previous lower abdominal operations, or for a patient who cannot tolerate general anaesthesia. One situation cannot wait. If the bulge becomes firm and painful and will not go back in, with vomiting or no passage of gas, the bowel may be trapped and its blood supply threatened. That is an emergency requiring urgent surgery, not a scheduled appointment. The limits must be stated. Hernia trusses and compression belts do not cure a hernia; they only ease the sensation temporarily and can cause harm. Abdominal exercises do not close the defect. Mesh reduces the chance of recurrence but does not abolish it, and surgery will not fix back pain or bloating unrelated to the hernia. If smoking, a chronic cough, constipation, excess weight or heavy lifting continue, the chance of recurrence rises. Possible complications include a fluid collection at the repair site, chronic pain in the area, temporary urinary retention, and rarely injury to vessels, nerves or bowel, or mesh infection. Whether laparoscopic or open repair suits you is decided by clinical examination and anaesthetic assessment, not by reading.
The hernia is examined standing, lying and with coughing to define its site and size and whether it reduces, with ultrasound or a CT scan when the diagnosis is uncertain or the hernia is large or recurrent. Previous operations and chronic conditions are reviewed and fitness for general anaesthesia is assessed.
You are advised to stop smoking before surgery, control diabetes and blood pressure, treat constipation, chronic cough and urinary symptoms in men, and lose weight where needed. Blood thinners are adjusted on written instructions from your doctor, and fasting before anaesthesia is specified.
Under general anaesthesia three small incisions are made and the abdomen is inflated with carbon dioxide. The camera is introduced, the defect is identified from inside, and the hernia contents, whether fat or bowel, are returned to the abdominal cavity. In inguinal hernia the other side is also inspected, which may reveal a hidden hernia.
A surgical mesh is positioned to cover the defect with an adequate margin around it and fixed with tacks, sutures or surgical glue depending on the type and site, and in some types the defect itself is closed before being covered. Haemostasis is confirmed and neighbouring organs checked before the instruments are withdrawn.
Discharge is usually the same day or after one night, with early walking, fluids and then light food. Discomfort, swelling and bruising in the area are expected for some weeks, and a fluid collection may look like the hernia returning and settles gradually. Desk work usually resumes within one to two weeks, and heavy lifting only after the period your surgeon specifies.
Tell the surgeon about all your medications, especially blood thinners and anticoagulants, aspirin, diabetes medicines and herbal supplements, and do not stop any of them except on written instructions. Mention previous abdominal and pelvic operations, because they determine whether a laparoscopic approach is feasible, along with any previous anaesthetic and problems with it, drug allergies, heart and lung disease, and any previous clot in the leg or lung. Report chronic cough, smoking, constipation and difficulty passing urine or a poor stream in men, since these raise the risk of recurrence and are best treated before surgery. Stop smoking some weeks before the operation if you can, and follow the fasting instructions from the anaesthetic team. Arrange someone to drive you and to help with lifting for the first two weeks.
Take short frequent walks from the first day to reduce the risk of clots, and avoid long periods sitting still. Support your abdomen with your hand when coughing or getting out of bed during the first days, drink enough fluids, include fibre and tell your doctor if you have not opened your bowels, so the repair is not strained. Expect swelling and bruising in the area, which in men may extend into the upper thigh or scrotum; this is common and settles over weeks, and a fluid collection at the mesh site may look like the hernia returning and gradually reduces. Do not lift heavy weights or do abdominal exercises or vigorous sport before the period your surgeon specifies, keep your follow-up appointments, avoid smoking, and maintain a healthy weight to reduce the chance of recurrence. Seek care immediately if you have: **a firm painful bulge that will not go back in, with vomiting or no passage of gas or stool, which is an emergency meaning the hernia is trapped, a temperature of 38C or above with shivering, sharply increasing pain after the second day, redness, warmth or pus from the incisions, inability to pass urine, severe and increasing scrotal swelling in men, or breathlessness, chest pain, or pain and swelling in one leg**.
The operation usually takes 45 to 90 minutes, longer for bilateral or recurrent hernias, with discharge the same day or after one night
الدكتور داوود محمود داوود — استشاري جراحة السمنة والمناظير والجراحة العامة في الأردن، وحاصل على البورد الأردني في الجراحة العامة، وعضو في جمعية الجرّاحين الأردن…
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