Hernia repair surgery – open or laparoscopic?

A minimally invasive, laparoscopic surgery is preferable, but unfortunately is not suitable to all hernia patients and types.

Whether it is inguinal, umbilical, or diaphragmatic, a hernia can affect different areas of the abdomen. The treatment of each case changes according to the area and condition severity. When is it possible to perform a laparoscopic procedure, and which cases require a more invasive, open surgery?

What is a hernia and what organs does it affect?

A hernia occurs when an inner organ pushes through a weak muscle or tissue that holds it in place. Usually referring to organs in the abdomen, due to congenital or degenerative weakness of the abdomen wall.

There are several types of hernias, depending on the location and affected organs:

The most common type of hernia is inguinal hernia, which is a hernia in the groin area. This area is week in both males and females. With males, the weak are is the hole that closes after the testicles drop in the early stages of a baby’s life. With females, it is the tissue holds the uterus in its place, which can be weak and sensitive.

Another type of hernia is in the umbilical area, which usually occurs with babies, in the area where the umbilical cord attaches to the baby while staying in his mother's womb. The area stays relatively weak after the hole attaching the baby to the mother closes, once the baby is born. Sometimes the hernia is congenital and sometimes it develops due to this weakness.

Another common hernia type is a hiatal hernia, which occurs when a part of the stomach pushes up through the diaphragm into the chest. This type of hernia is most common in patients older than 50, and in younger patients with a congenital defect.

Other types of hernias, which are less common, include all kind of abdominal hernias, created inside the abdomen, allowing inner organs to enter each other without an external sign. Another kind of hernia is caused when incisions made in other surgical interventions weakening the tissue.

Open hernia repair surgery

In an open, traditional hernia surgery, a deep incision is made into the affected area. The recovery time for such a procedure is relatively long, and the aesthetic result is not very pleasing. The hole in the tissue is, in most cases, "patched" with a biologic or synthetic material, to cover the gash and prevent the organs from moving freely. There are several types of patches, made from a net. Usually a net made from a biologic material higher resistant to infections, bot is also more costly and less durable than its synthetic replacement.

Laparoscopic hernia repair surgery

Each type of hernia requires a certain patch and a certain applying method to cover it properly. In the laparoscopic method, the, patch (or net), is inserted to the body, not through a wide incision in the affected area, but through tiny incisions made around it. A microscopic camera is inserted through one incision, so the surgeon can see the inside of the hernia, and the other openings allow tools inside the body. The advantages of the laparoscopic method are shorter recovery, lower risk of infections and a visually pleasing result.

How to choose a surgery method?

Even though the laparoscopic method has major advantages, it is not suitable for every patient. For example, if a patient suffers from big hernias in the abdomen wall, due to previous surgeries, this method will not serve him well. Some surgeons even think that this type of procedure can endanger the colon, and prefer using the open method, where they can treat the sensitive area with full vision. However, more experienced surgeons would prefer the less invasive method.

Doctor Yuri Mnouskin - specializes in general surgery and minimally invasive surgical methods. Deputy Chief of general and vascular surgery department, Barzilay Medical Center. Senior surgeon at Herzliya Medical Center.
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