Femoral Hernia Repair

A hernia occurs when the internal organs of the abdominal cavity push through a weakened spot in the abdominal wall to form a bulge. Hernias occur most commonly between the area of your rib cage and groin.

Hernias may be repaired surgically by closing the defect and using mesh to strengthen the weakened area. This can be performed in a minimally invasive manner using a laparoscope.

 

Laparoscopic Hernia Repair

A hernia is a sac-like structure that protrudes from a weak area or opening in the wall of the abdominal cavity. It is seen as a bulge over the skin, and often characterised with pain and discomfort. The most commonly used laparoscopic surgical techniques for hernia repair are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair.

 

Open Hernia Repair

A hernia occurs when an organ or fatty tissue protrudes through a weak area in the surrounding muscle or connective tissue called the fascia. The most common types of hernias include inguinal (inner groin), incisional (occurring as a result of an incision), femoral (outer groin), umbilical (bellybutton), and hiatal (upper stomach).

 

Laparoscopic Mesh Repair of Inguinal Hernia

A hernia occurs when the internal organs of the abdominal cavity push through a weakened spot in the abdominal wall to form a bulge. Hernias occur most commonly between the area of your rib cage and groin.

Hernias may be repaired surgically by closing the defect and using mesh to strengthen the weakened area. This can be performed in a minimally invasive manner using a laparoscope.

 

Mesh Repair of Umbilical and Paraumbilical Hernia

An umbilical or paraumbilical hernia is a weakness in the abdominal wall at or near the navel through which the contents of the abdomen protrude to form a bulge.

 

Dr Sumeet Toshniwal - Groin Hernia Surgery Comparison

  Open Hernia Surgery Laparoscopic Hernia Surgery Total Extraperitoneal Hernia Surgery
Surgery Summary
About Most common technique used for hernia repair. Less common approach for hernia repair. Most advanced technique. Suitable for unilateral, bilateral and recurrent hernias repair.
Suitable For Elderly people or any patient not eligable for Laparoscopic / Extraperitonal Repair (eg: unable to have general anaesthesia) Suitable for patients who have had previous robotic prostatectomy or an hysterectomy Suitable for all patients except patients ineligible for general anaesthesia or ineligible for open lower abdominal surgery
All Ages Any Age Less than 80 year old preferred Less than 80 year old preferred
Obese Patients Less suitable for obese patients as more invasive, with larger incision and surgical dissection More suitable for obese patients as the procedure is less invasive and requires less surgical dissection Most suitable for obese patients as the procedure is less invasive and requires less surgical dissection
Surgical Overview
Benefits Common experience, widely available. And is used for some large, chronic, long standing hernias can be difficult to repair. Keyhole procedure, preserves structure of the muscle tissue, less invasive, faster recovery Least invasive, less pain both post operative and long term chronic nerve pain due to less muscle and nerve damage. Lower rate of hernia recurrence. Quicker return to normal activities (e.g. Work, sport etc)
Disadvantages Most invasive procedure. Increased postoperative pain from muscle and nerve damage. Higher rate of hernia recurrence. Slower return to normal Higher risk of adhesion and bowel injury than Total Extraperitoneal Hernia Surgery Only disadvantage are the normal risks associated with surgery
Surgical Duration Surgery is usually about 30-45 minutes in length. Surgery is about 45-60 minutes in length. Surgery requires more time approx 60+ minutes in duration
Skill Level Very common with significant variation in surgical techniques and outcomes Requires advanced experience and laparoscopic surgery skills Requires the highest level of Hernia repair skills.
Fee Comparison Most cost effective option for cash patients. Higher costs for cash patients due to the additional laparoscopic equipment needed. Higher costs for cash patients due to the additional laparoscopic equipment needed.
Surgical Preparation Basic preoperative workup is required. Occasionally requires more advanced workup because general anesthesia is used. Occasionally requires more advanced workup because general anesthesia is used.
Surgical Requirement Standard surgical equipment. Advanced laparoscopic equipment. Advanced laparoscopic equipment.
Surgery Details
Method Surgery involves folding away the tissue and muscle layers to access a herniated tissue underneath This procedure uses a small keyhole Incision using minimally invasive surgery but uses a peritoneal incision that requires stitching. Method involves no muscle dissection and considerably less local trauma or peritoneal stitching
Surgical Approach Hernia is fixed by opening the muscles over the weakness. Hernia is fixed from the inside, behind the muscles where the weakness is located. The most anatomical repair as it matches the natural anatomy
Mesh Placement Mesh is placed behind the muscle and above the muscle. The mesh is sutured in place. The peritoneum is cut, the mesh is placed between the peritoneum and the muscle. The mesh is secured in place with absorbable sutures. This method involves no peritoneal dissections staying behind the muscle and in front of the peritoneal sac and the mesh is placed between the two
Type of Mesh Used Traditionally a heavier prolene mesh is used Lightweight mesh. Less scarring, pain and post op infection Lightweight mesh. Less scarring, pain and post op infection
Access to the Hernia 4-5 cm incision in the groin or bikini area. 1-2 cm incision next to the belly button, and 2 small punctures below the belly button. 1-2 cm incision next to the belly button, and 2 small punctures below the belly button.
Procedural Anesthesia Can be done under local or spinal anesthesia with sedation. Requires complete general anesthesia. Requires complete general anesthesia.
Completing the procedure Surgeon sutures required to close the surgical area Small the port hole closed with tape Small the port hole closed with tape
Recovery from Surgery
Post Op Pain On average, 1/3 of patients have little to no pain after surgery. 2/3 have moderate pain post op. Less Pain - on average, 2/3 of patients have little to no pain after surgery. 1/3 have moderate pain post op. Less Pain - on average, most patients have any discomfort after surgery. Some develop temporary bruising around lower abdomen
Potential complications Possible chronic pain, numbness and infection. Possible postoperative adhesions and bowel injury Rare possibility of injury to major blood vessels
Infection Rates Highest Low Very Low
Bandage Bandage and drainage for 3 weeks after surgery Local area recover within 1-2 weeks after surgery Local area recover within 1-2 weeks after surgery
Healing Variable post op outcomes. In some incidences patients suffer discomfort and movement restrictions Patients most experience a quick return to normal, with little post op discomfort or movement restrictions Patients most experience a quick return to normal, with little post op discomfort or movement restrictions
Activity restrictions Most patients will return to normal activities within 3-6 weeks. Most patients will return to normal activities within 1-2 weeks. Most patients will return to normal activities within 1-2 weeks.
Recurrence Rates Highest Low Very Low