What is Keyhole Surgery?
Laparoscopic inguinal hernia repair uses an instrument called a laparoscope. Three incisions are made through the abdominal wall through which are passed the laparoscope (a thin telescope with a light on the end) and surgical instruments into the abdomen. The incisions are small, so the whole technique is often called keyhole surgery. (Conventional surgery is called open surgery.) It is also often referred to as minimally invasive or minimal access surgery.
The hernia is then viewed from inside the abdomen, from the other side of the abdominal wall.
The abdominal cavity is inflated with carbon dioxide gas to give the surgeon space to work inside the patient and the actual operating is done remotely with long instruments. The hernia defect or hole is covered with mesh from within the abdomen and staples commonly fired through it into the muscle tissue in order to fix it as a patch.
When done well, by well-trained and experienced surgeons in appropriately selected cases, the results of keyhole inguinal hernia repair are excellent and it is our preferred method for surgery.
Pain after Keyhole Surgery
In practice and depending upon how it is performed, you can get quite a lot of pain after a laparoscopic inguinal hernia repair, because the pain does not come only from the skin cuts. The pain is more likely to be related to the fact that the deep tissues have been cut and pulled, and staples (dissolving) may have been used to fix the mesh.
- It is technically demanding for the surgeon. What that really means is that its difficult to learn and difficult to do well. He / she has to practice a great deal and perform a large number to become really good at it.
- Due to the nature of the operation there is the risk of organ damage (blood vessel, bowel and bladder). This risk is greater if there has been prior surgery in the area.
- Keyhole repairs have to be done under general anaesthesia. That carries risks on its own and certainly not so good if you are elderly or have other medical conditions.
- Cost – Laparoscopic repair involves the use of specific hi tech equipment and the cost (paid by the health fund) is about three times the cost of an open repair. As a result it has been discouraged in preference to open repair because of this, and only recently has it become available in government funded centres.
- If there has been a previous failed open repair, particularly if mesh was used ‘unsuccessfully’ or perhaps, inexpertly.
- If there is an inguinal hernia on both sides (a bilateral hernia) and both are to be repaired at the same time If your surgeon is skilled in this technique it may be their preferred option.