WHAT IS A HERNIA?

• Unless prevented by unusual circumstances we do Laparoscopic inguinal and Ventral hernia repair.
• The inquinal repairs are done by TEP preperitoneal or extraperitoneal methods and also by TAPP or transperitoneal method.
• The repairs can be expected to achieve a 99% effective repair rate and generally are considered to be strong enough to enable heavy work.
• The repair materials include the most modern available including pericardial patch materials which have been approved by Health Canada and the US FDA for the applications. We are pleased to offer the PMD biological pericardial patch which we believe is superior in handling and postoperative comfort and has been used for a great many years as a dural patch, a carotid artery patch and a patch for the pericardium itself because of its long term performance and reliability in these demanding locations. Also available are Johnson and Johnson Prolene mesh patches.
• Dr. Pacey, a Vascular and General surgeon. takes a special interest in being on the forefront of new technologies in this and other laparoscopic areas.
• High Quality video equipment at False Creek makes this work possible at this level.
• Challenging repeat surgery cases are welcome for definitive repair.

A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. Hernias can develop around the naval, in the groin, or any place where you may have had a surgical incision. It can be congenital (at birth), others develop slowly over a period of months or years or a traumatic origin.

Hernia repair is one of the most common surgical procedures performed. Every year, over one half million North Americans undergo surgery for the treatment of this problem.

The most common of all hernias, the inguinal, occurs in the groin area. Protrusions elsewhere on the abdominal wall are called femoral and umbilical hernias. Highest up of all is the hiatal hernia, which occurs when part of the stomach pushes through the diaphragm separating the chest and the abdomen.

Four different types of hernias account for almost 100% of the hernias repaired by surgeons:

OPEN HERNIA REPAIR (HERNIORRHAPHY, HERNIOPLASTY)

For open hernia repair surgery, an incision is made in the groin area. If the hernia is bulging out of the abdominal wall, the bulge is pushed back into place. If the hernia is going down the inguinal canal, the hernia sac is tied off and removed or pushed back.

The weak spot in the muscle wall (where the hernia bulges through) traditionally has been repaired by sewing the edges of healthy muscle tissue together (herniorrhaphy). This is appropriate for smaller hernias that have been present since birth and for healthy tissues, where it is possible to use stitches without adding stress on the tissue. The surgical approach varies, depending on the area of muscle wall to be repaired and the surgeon's preference.

Often mesh patches of synthetic material are sewn over the weakened area in the abdominal wall after the hernia is pushed back into place. The patch decreases the tension on the weakened abdominal wall. This may reduce the risk a hernia will recur.

LAPAROSCOPIC HERNIA REPAIR

Laparoscopic hernia repair is similar to other laparoscopic procedures. The person having laparoscopic hernia repair is given general anaesthesia. A small incision is made in or just below the belly button (navel). The abdomen is inflated with carbon dioxide to separate the abdominal organs so the surgeon can see the organs more clearly and avoid injuring them or the inside of the abdominal cavity.

In laparoscopic hernia repair, the surgeon inserts a laparoscope (a long, thin, metal device with a light and magnifying lens) through a small incision. The laparoscope is used to visualize the hernia and then with titanium staples a mesh patch is affixed behind the abdominal muscle wall; in this technique, the patch rests against the thin inner lining of the abdomen.

• Most people who have laparoscopic hernia repair surgery are able to go home the same day.
• Recovery time from laparoscopic hernia repair is about 1 to 2 weeks.
• Studies have found there is less pain after laparoscopic hernia repair than after open hernia surgery.

Types of laparoscopic hernia repair:

Trans Abdominal Pre-Peritoneal (TAPP): With this technique, the pre-peritoneal space is accessed from the abdominal cavity and a mesh is then placed and secured with titanium staples. This is a very popular repair, used at many centers worldwide, and it is the procedure of choice for recurrent inguinal hernias.

• 1% recurrence rate.
• Frequently used for repairing recurrent hernias (after open surgery).

Totally Extra-Peritoneal (TEP): The mesh is again placed in the retroperitoneal space suing titanium staples, but in this case, the space is accessed without violating the abdominal cavity. This is probably the most physiological repair although technically more demanding.

TEP Benefits:

• 1% recurrence rate
• Least invasive – don't enter the abdominal cavity
• Minimal pain and able to return to work more quickly.