Laparoscopic groin hernia repair
(Extraperitoneal)
Laparoscopic groin hernia repair can take place in two ways: through the abdominal cavity or inside the abdominal wall, the so called extraperitoneal space. This last method is often preferred because one doesn’t have to jeopardize the abdominal cavity.
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By means of a small incision of approximately 1,5cm to the lower edge of the umbilicus a camera system in the abdominal wall is introduced superficially to the abdominal membrane (1). This space is filled with CO2 gas so that the abdominal membrane with the abdominal contents is shoved aside down and backwards, so the surgeon improves visibility and is able to free the structures of the hernia. The bone of the pelvis comes in site(2).
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Hereafter through one or two small incisions of 0,5cm instruments are introduced and the hernia and the spermatic cord are freed (3). Depending on of the position of the hernia in relation to the blood vessels, one speaks of a lateral (3) or medial (4) hernia. The herniasac (a bulge of the abdominal membrane) is withdrawn in a sufficiently wide area to be able to place a nonsoluble mesh at the weak spot in the abdominal wall(5,6).
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The mesh (7) is introduced and is then rolled out at the weak spot(8,9). If there is a hernia at both sides (left and right) two meshes(10) or one large one are introduced. If the meshes are in place the gas is removed from the space and then the abdominal membrane with its contents presses the mesh in its place. This grows rapidly in the surrounding tissues and gives in this way strengthening of the abdominal wall.
After approximately two days all activities are permitted in contrast to the groin hernia operations where no mesh is used. Sometimes a swelling continues to exist in the groin: this is caused by wound fluid in the old cavity of the sac. This disappears automatically within four up to six weeks.
This is how it looks 8 weeks after an operation for a doublesided hernia