Laparoscopic Hernia Repair

Laparoscopic Hernia Repair

Laparoscopic Inguinal Hernia Repair

There are many different techniques used to repair inguinal hernias. Recent data has proven the longstanding theory that mesh behind the abdominal wall (posterior approach) is the best approach to mesh hernia repair. When compared with the anterior approach, where mesh is placed between the muscle layers, the posterior approach has a lower risk of recurrence and chronic pain. Patients who undergo a posterior approach typically recover faster, with less pain, and can return to exercise much sooner. 

There are a few different approaches to a posterior mesh repair

  1. Posterior Open approach - through one incision in the groin done under direct visualization
    - Fast Recovery Inguinal Hernia Surgery is best for patients who are healthy, active, and want to avoid general anesthesia

  2. Laparoscopic approach - through 3 small incisions using a camera
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    This approach is ideal for patients with a higher BMI or who have certain other medical concerns

  3. Robotic approach - a new, expensive platform that performs the same as laparoscopic approach in terms of the procedure itself as well as outcomes
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    We do not currently offer this approach as there is no data to show improved patient outcomes for hernia surgery

 

At Boston Hernia, our goal is to provide individualized care for each patient, taking into consideration each patient’s story and medical history. This means offering multiple different approaches to hernia surgery. 

Dr. Reinhorn has performed the Fast Recovery Inguinal Hernia Surgery since 2004, after over 500 laparoscopic hernia surgeries, because he found patients had less pain and were often able to avoid general anesthesia. This approach serves many patients, but there are some who would benefit from a laparoscopic approach for various reasons. In May 2021, with the addition of Dr. Fullington, Boston Hernia is happy to offer laparoscopic repair for those who would benefit from this approach.

For those patients who have a thicker abdominal wall, typically associated with higher BMI (Body Mass Index), a laparoscopic approach is likely the best option. Laparoscopic inguinal hernia repair is performed through 3-4 small incisions in the abdominal wall, and instruments including a laparoscope are inserted through these incisions. A laparoscope is a tiny camera that is used to visualize the hernia from within the abdomen. After the hernia is returned into the abdominal cavity, a piece of mesh is placed over the defect to repair the hernia. The mesh is placed behind the abdominal wall (posteriorly), in the same position as the open preperitoneal repair.

A laparoscopic hernia repair is almost always an outpatient surgery, meaning patients go home afterwards. Patients are in the hospital or surgery center for about 5-6 hours in total. The procedure itself takes about one hour and then patients wake up in the recovery room for a couple hours before heading home to continue recovering. This type of surgery requires general anesthesia because the body has to be completely relaxed during this procedure. Most patients can leave the hospital 2-3 hours after general anesthesia, although it is normal to feel groggy or tired for a full day after surgery.

While recovery is different for each person, most patients feel they can return to walking within a couple of days and exercise after a couple of weeks. We recommend avoiding strenuous activities including exercise and heavy lifting for at least two weeks after surgery. After two weeks, patients can slowly resume exercise as tolerated. This is a much quicker recovery compared to the traditional anterior mesh hernia repair which requires 4-6 weeks of recovery. Please see our Laparoscopic Hernia Repair Post-op Instructions for more details about recovery.