Laparoscopic Inguinal Hernia Repair

The pre-operative assessment of the patient, and the precautions against infection and DVT are identical to the open “mesh” procedure. The surgery requires the development of a preperitoneal space behind the abdominal muscles using a balloon dissector in the first instance and a subsequent structural balloon to maintain the space, together with insufflation with Carbon dioxide to facilitate visual access. The crucial aspects of the operation include the development of the preperitoneal space, adequate definition of the anatomy, and the complete reduction of the hernial sac, well back to within the abdominal cavity. The anatomy is carefully defined, the hernial sac dissected free and reduced, care taken to protect the spermatic cord structures. It is important to assess for both direct and indirect inguinal, and femoral hernias, which may occur concurrently. A large, lightweight, polypropylene mesh, 6 x 4 inches, preformed according to the shape of the pelvis is inserted. The mesh is positioned to cover all of the hernial defects using dissolving “tacks” to hold it in place. The preperitoneal space is deflated and the wounds closed. An assistant surgeon with experience in laparoscopic procedures is a key member of the surgical team.