The revolution in the surgical treatment of hernias is the minimally invasive (laparoscopic) approach with placement of a mesh.
Laparoscopic repair of ventral hernias (umbilical, epigastric, incisional hernia)
The laparoscopic ventral hernia repair is performed with the insertion of a camera through an incision of 10 mm in diameter and 2-3 instruments of 5 mm each, inside the abdominal cavity. This approach allows the surgeon to assess the hernia from the inner side of the abdominal wall. By using laparoscopic instruments, all adhesions of the bowel inside the hernia sac are precisely cut, avoiding any injuries. A mesh (synthetic material) is then placed to cover the gap of the hernia (intraperitoneally) and it is firmly attached to the muscles of the abdominal wall. The incisions are minimal, the pain is almost absent, the patient returns to oral diet immediately after the procedure and he/she is discharged from the hospital the next day, without any drains that are usually required in the open technique.
Laparoscopic repair of inguinal and femoral hernias
The operation is carried out through 3 small incisions, one 10 mm below the umbilicus through which the optical scope (camera) is inserted and two 5 mm for the insertion of the surgical instruments. The hernia sac is reduced, and the weak posterior abdominal wall is reinforced with the use of a mesh. The mesh, sized 10 × 15 cm, is a non-absorbable and perfectly bio-compatible material. The laparoscopic technique that we perform is the extraperitoneal endoscopic technique (TEP – totally extraperitoneal repair), which is considered the safest method for inguinal hernia repair, since it is performed between the muscular layers of the abdomen, without any contact with the intraabdominal organs. Laparoscopic access is also ideal for the treatment of bilateral inguinal hernias, since both sides are approached using the same small incisions but also for most sports hernias, since it achieves the reinforcement of the posterior abdominal wall without big incisions and extended manipulations.
Laparoscopic repair of hiatal hernias
The laparoscopic hiatal hernia repair is carried out through 4-5 small incisions (5-10 mm) on the skin. The laparoscope, which is connected to a high-resolution monitor allows the surgeon to see the patient’s intraabdominal organs enlarged. The repair of the hernia is done by suturing the diaphragmatic crura. In most cases, due to the coexistence of gastroesophageal reflux disease, an anti-reflux procedure is also performed. This is done by wrapping the fundus of the stomach around the lower part of the esophagus (laparoscopic Nissen fundoplication). In this way, the hernia, as well as the excruciating and potentially dangerous acid reflux from the stomach to the esophagus, are treated simultaneously.
Advantages of laparoscopic hernia repair:
- Minimal or even absent postoperative pain
- Fast recovery (even day surgery) and quick return to everyday activities and work
- Excellent aesthetic results