A hernia is simply a point in the abdomen where there is a gap in the muscle layer allowing the fat and other structures deep to the muscle to bulge through.
In some parts of the body, such as the groin, there is already a tiny gap in the muscle so that structures such as blood vessels can pass through. A hernia develops when this tiny gap becomes larger for any reason.
Other hernias such as incisional hernias and ventral hernias occur where a new gap opens up in the muscle - in the case of incisional hernias, this occurs where there has been a previous operation scar and is due to the fact that a healed muscle scar is never as strong as the original muscle.
All hernias can be repaired either by open surgery or laparoscopic(keyhole) surgery. For a very small incisional or umbilical hernia, there is little benefit in doing keyhole surgery, as the incision is itself very small.
At the other end of the scale, some incisional hernias are simply too big to repair effectively by keyhole surgery. Other rarer types of hernia, such as Spigellian hernia, lumbar hernia and para-stomal hernias can be repaired by either laparoscopic or open surgery.
TEP Hernia Repair
The most common type of hernia is a groin hernia medically called an Inguinal hernia
These are extremely common in men and fairly common in women too. They are often repaired by open surgery, usually involving the placement of a re-inforcing surgical mesh.
I use the laparoscopic method of repair know as the Totally Extra-peritoneal - or TEP approach. This technique has advantages over an open repair, it is a minimally invasive operation with only three very small incisions & the recovery time is much shorter. It is also easy to repair a double (bilateral) hernia using the same incisions if a double hernia has been identified.
This method of repair involves the least amount of trauma to the tissues of the lower abdomen.
The TEP method of repair is also effective in repairing a recurrent hernia which has reoccured after a previous open hernia repair.
The TEP approach can also be used to repair a Femoral hernia. In some circumstances it is not possible to do this type of repair due to previous abdominal surgery. In these instances, a variation of this technique, called Trans-abdominal, Pre-peritoneal (TAPP) repair can be used to similar good effect.
Incisional hernias come in all shapes and sizes and depend on the site and size of the previous operation scar, as well as whether there were any complications of the previous operation such as a wound infections, or previous attempts at repairing them.
These hernias need an individualised approach to their repair. Some small incisional hernias are simple to repair with a small open operation through a very small new incision.
Many of the larger hernias can be repaired very effectively using keyhole surgery with surgical mesh used inside the abdomen to re-inforce the repair. Very large and problematic incisional hernias, often in areas where there have been multiple previous surgeries, often require an open operation to repair them effectively.