Laparoscopic Inguinal Hernia Repair

Inguinal Hernias are a common problem, especially in the male population. An inguinal hernia develops in the groin, and manifests by a bulge in the groin area, to one side or the other. The bulge is usually smallest in the morning, and increases in size during the day. Sometimes, people feel pain in the area of the bulge, or down to the inner thigh or to the testicle (in males). A bulge in the groin which comes and goes is almost always a hernia, and is usually diagnosed by the doctor, or sometimes by the patients themselves.

Anatomically, the hernia forms because the inguinal canal, which is the opening in the abdominal wall where the testicle migrates during fetal formation, stays open. Eventually, since the opening has never closed, the last remnants of the abdominal wall wear away with pressure (lifting heavy objects, coughing, working out). Ultimately, once a hernia forms, it can never become undone. Working out, yoga, herbal supplements, alternative medicine, will NOT make a hernia ever go away. The only cure for a hernia is surgery, since there is literally an opening in the abdominal wall. The opening needs to be closed.

The surgical options are either open, or classical, hernia repair, or the more newly established, laparoscopic hernia repair. There are advantages and disadvantages to both, but the trend is toward laparoscopic repair because the advantages, far outweigh the disadvantages as the surgeon experience and knowledge level increases.

The method of the laparoscopic repair is complex and simplistic at the same time. The simplistic aspect is that the opening is repaired by laying a mesh over the opening from the inner aspect of the abdominal cavity. More specifically, the layers of the abdominal wall are gently split apart with pressurized gas, and the opening is seen within that space. The mesh is placed by rolling it up, inserting it through one of the three tubes (trocars) which go through the abdominal wall, and unrolling it on the inside of the wall over the opening, as if one were wall papering the wall over the defect. Eventually, the body uses the mesh as a lattice to grow into, creating a scar tissue plate which plugs the hole (hernia defect). The largest incision ever made during this repair is a 1 cm cut. All other layers are left intact. Down time, recovery, healing are all decreased with this method.

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