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Expert Speak

Laparoscopic Hernia Repair

Many thousands of Indians undergo hernia surgery each year. Dr Vikram Ananthakrishnan, a general surgeon, answers some frequently asked questions about hernia and the methods of treatment available.

What is hernia?

Sometimes the muscles of the lower abdomen weaken and they tear a bit. The inner wall of the abdomen called the peritoneum pushes out through this opening, showing up as a bulge in the groin area. Sometimes a part of the intestine can also get trapped in this bulge and the problem becomes severe.

There is pain in the abdominal area. It can be a dull pain or a sharp one. The pain shoots up when the person lifts weights or has a coughing bout. It worsens at the end of the day.

What causes hernia?

Hernia cannot be put down to a single cause. People of all ages and both sexes get hernias. The walls of the abdomen have areas of weakness. Heavy strain on the abdomen, persistent cough, ageing, injury, an old incision or a congenital defect have all been observed to cause hernias.

What are the treatment options?

Most hernias require surgery.

Today surgery is performed in two ways: the traditional and the laparoscopic.

Traditional Surgery (Open hernia repair): In this procedure the surgeon cuts through the skin, subcutaneous fat, and then gets to the area of the problem. He needs to make a fairly big incision. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anaesthetic but may be performed using a spinal or general anaesthetic.

Laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.

Other tubes are inserted which allow your surgeon to work "inside." The hernia is repaired from behind the abdominal wall. Here too a surgical mesh or screen is fixed over the problem area and held in place with small surgical staples. 3 or 4 quarter inch incisions are usually necessary. This operation is usually performed with general anaesthesia or occasionally using regional or spinal anaesthesia

What are the Advantages of laparoscopic hernia repair?

  • It is relatively pain free
  • It enables the patient to move easily
  • It is cosmetically better.

What are the disadvantages of laparoscopic hernia repair?

  • The recurrence rates are high.
  • Postoperative pain can be present due to a nerve being clipped.
  • Large and complicated hernias cannot be repaired successfully.
  • It is much more expensive than the traditional type of surgery.

Precautions to be followed before surgery

  • The patient should stop smoking.
  • If the patient has cough, it must be treated.
  • If there is difficulty in passing either urine or stools, it must be attended to.
  • Some drugs should be stopped before surgery (Patients on aspirin or anti coagulants should stop these drugs.)

Some clarifications about lifestyle after the operation.

(These are answers to the questions hernia repair patients usually ask me)

After surgery the patient may:

  • Return to work within 7 days.
  • Climb stairs
  • Exercise
  • Drive a car or ride a bike
  • In short, all normal routine activity is permitted.

After surgery the patient should not:

  • Lift heavy weights.
Dr. Vikram Ananthakrishnan M.S., D.N.B., F.R.C.S.

Dr.Vikram Ananthakrishnan completed his M.S. in General Surgery from the Grant Medical College, Bombay and then his Diplomate of The National Board, India (D.N.B). He completed his F.R.C.S. from Royal College of Surgeons, Glasgow, U.K.

Dr.Vikram is currently an Assistant Professor in the Department of General Surgery at Sri Ramachandra Medical College, Chennai. He is also a visiting consultant at The Apollo Hospitals, Chennai. His special area of interest is laparoscopic surgery, colon & rectal surgery.

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