What can I expect during the procedure?
In the anaesthetic bay of the operating theatre a small plastic tube (called a cannula) will be placed into a vein in the arm or hand. If the procedure is being done under general anaesthetic, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic. Once it has taken effect, you'll be taken to the operating theatre.
The procedure will differ based on the type and location of the hernia, and to some extent the preference of the surgeon. There are two main types of operation: laparoscopic (keyhole), and open repair. Laparoscopic repair is used predominantly (although not exclusively) for inguinal and incisional hernias.
Three tiny cuts are made in the wall of the abdomen. A balloon dilating apparatus is put in and moved down to the pubic bone between the abdominal muscles and stomach lining.
The balloon is inflated to separate the lining from the layer of muscle. It’s then removed an replaced with a tube (called a laparoscopic port). The area is expanded with water and a telescope is put into the space.
Two more minute incisions are made on the opposite side of the hernia, between the umbilicus and pubic bone, to make room for the surgical instruments. A space is created so the defect of the muscle can be seen clearly.
The hernia is then pulled back into the space and a piece of flexible mesh is guided down the port and put in place to cover the weak areas. The mesh is held in place by around 10 tacking devices.
Anaesthetic is put into the space before the surgeon withdraws the ports. The small incisions are then closed with dissolving stitches.
The pressure in the cavity of the abdomen pushes onto the mesh and traps it, holding it in place. With any straining or increase in pressure in the abdomen, the mesh is pressed firmly against the abdominal wall, helping to stop the repair pulling apart.
This method is not as painful as an open repair, and recovery times are generally shorter as it is far less invasive.
An incision is made through the skin, outer layer of the abdominal wall and muscle overlying the area. The size of the incision depends on the size and position of the hernia.
As with the laparoscopic technique, your surgeon will usually use a mesh to reinforce the weak abdominal wall. This is stitched or stapled into place without tension, and is therefore known as a tension-free repair. Older techniques involved tightly stitching together the area, which lead to longer recovery times and a higher rate of hernia recurrence.
The area of the groin is cleaned with an antiseptic solution. A small incision is made in the groin on the side of the hydrocoele. The blood vessel leading to the testis and the tube that carries sperm from the testicle to the penis are freed up from the surrounding tissues. The pocket of abdominal lining is separated out and tied off. The fluid is then drained from around the testis.
The other tissues are returned to their normal position and the wound is sutured closed under the skin. In most cases absorbable sutures are used. The wound is then covered with a water-resistant dressing.