Keyhole or Laparoscopic Incisional Hernia Repair
Minimally invasive incisional hernia repair is a recent addition to repair of abdominal wall hernia. A telescope and 2 or 3 additional ports allow the contents of the hernia to be reduced and mesh to be placed on the inside of the abdominal wall covering the hernial defect. It may be possible to suture the defect closed first and reinforce the repair with mesh which is stapled and sutured to the abdominal wall.
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An incisional hernia is repaired for symptom relief due to size or pain, cosmesis or prevention of complications such as acute incarceration and skin problems but the new keyhole repair does not have much advantage over open surgery.
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There is little difference in post operative pain but return to work may be quicker with the laparoscopic repair. Recurrence rates are similar.
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The role of the keyhole or laparoscopic operation remains controversial and However the operation is suited to some incisional hernia.
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There are surgical issues that make laparoscpic repair difficult. For example just entering the abdominal cavity can be problematic because of previous surgery and underlying bowel adhesions. The external hernia sac is not removed, leaving a swelling that may look as though the hernia has not been fixed. A big incisional hernia may need a 'tummy tuck' to remove the redundant skin and this negates the advantage of not having a bigger incision. Dissection of the hernia from inside can be difficult especially if the hernia has been present for a long time. Large hernia greater than 10 - 15 cm can be difficult to repair. There is a limited ability to close the muscle margins producing a less 'functional' repair.
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It is difficult to compare operative results because of patient selection and differing techniques. Surgeons each have their own opinion.
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The decision to use the laparoscopic approach should be discussed with your surgeon. In general the keyhole operation should be considered for smaller incisional or ventral hernia that are not incarcerated, have not had previous repairs and do not have a large sac with redundant skin.
