|
Open Hernia Surgery |
Laparoscopic Hernia Surgery |
Total Extraperitoneal Hernia Surgery
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| Surgery Summary |
| About |
Most common technique used for hernia repair. |
Less common approach for hernia repair. |
Most advanced technique. Suitable for unilateral, bilateral and recurrent hernias repair.
|
| Suitable For
|
Elderly people or any patient not eligable for Laparoscopic / Extraperitonal Repair (eg: unable to have general anaesthesia)
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Suitable for patients who have had previous robotic prostatectomy or an hysterectomy
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Suitable for all patients except patients ineligible for general anaesthesia or ineligible for open lower abdominal surgery
|
| All Ages |
Any Age |
Less than 80 year old preferred |
Less than 80 year old preferred |
| Obese Patients |
Less suitable for obese patients as more invasive, with larger incision and surgical dissection
|
More suitable for obese patients as the procedure is less invasive and requires less surgical dissection |
Most suitable for obese patients as the procedure is less invasive and requires less surgical dissection |
Surgical Overview
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| Benefits |
Common experience, widely available. And is used for some large, chronic, long standing hernias can be difficult to repair.
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Keyhole procedure, preserves structure of the muscle tissue, less invasive, faster recovery
|
Least invasive, less pain both post operative and long term chronic nerve pain due to less muscle and nerve damage. Lower rate of hernia recurrence. Quicker return to normal activities (e.g. Work, sport etc)
|
| Disadvantages |
Most invasive procedure. Increased postoperative pain from muscle and nerve damage. Higher rate of hernia recurrence. Slower return to normal
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Higher risk of adhesion and bowel injury than Total Extraperitoneal Hernia Surgery
|
Only disadvantage are the normal risks associated with surgery |
| Surgical Duration |
Surgery is usually about 30-45 minutes in length. |
Surgery is about 45-60 minutes in length. |
Surgery requires more time approx 60+ minutes in duration
|
| Skill Level |
Very common with significant variation in surgical techniques and outcomes
|
Requires advanced experience and laparoscopic surgery skills |
Requires the highest level of Hernia repair skills. |
| Fee Comparison |
Most cost effective option for cash patients. |
Higher costs for cash patients due to the additional
laparoscopic equipment needed. |
Higher costs for cash patients due to the additional
laparoscopic equipment needed. |
| Surgical
Preparation |
Basic preoperative workup is required. |
Occasionally requires more advanced workup because
general anesthesia is used. |
Occasionally requires more advanced workup because
general anesthesia is used.
|
| Surgical
Requirement |
Standard surgical equipment. |
Advanced laparoscopic equipment. |
Advanced laparoscopic equipment. |
| Surgery Details
|
| Method |
Surgery involves folding away the tissue and
muscle layers to access a herniated tissue
underneath |
This procedure uses a small keyhole Incision using
minimally invasive surgery but uses a peritoneal incision
that requires stitching.
|
Method involves no muscle dissection and considerably less
local trauma or peritoneal stitching
|
| Surgical
Approach |
Hernia is fixed by opening the muscles over the
weakness.
|
Hernia is fixed from the inside, behind the muscles where
the weakness is located.
|
The most anatomical repair as it matches the natural
anatomy |
| Mesh Placement |
Mesh is placed behind the muscle and above the
muscle. The mesh is sutured in place. |
The peritoneum is cut, the mesh is placed between the
peritoneum and the muscle. The mesh is secured in
place with absorbable sutures.
|
This method involves no peritoneal dissections staying
behind the muscle and in front of the peritoneal sac and the
mesh is placed between the two
|
| Type of Mesh
Used |
Traditionally a heavier prolene mesh is used |
Lightweight mesh. Less scarring, pain and post op
infection |
Lightweight mesh. Less scarring, pain and post op infection |
| Access to the
Hernia |
4-5 cm incision in the groin or bikini area. |
1-2 cm incision next to the belly button, and 2 small
punctures below the belly button.
|
1-2 cm incision next to the belly button, and 2 small
punctures below the belly button.
|
| Procedural
Anesthesia |
Can be done under local or spinal anesthesia with
sedation. |
Requires complete general anesthesia. |
Requires complete general anesthesia. |
| Completing the
procedure
|
Surgeon sutures required to close the surgical
area |
Small the port hole closed with tape |
Small the port hole closed with tape |
| Recovery from Surgery
|
| Post Op Pain |
On average, 1/3 of patients have little to no pain
after surgery. 2/3 have moderate pain post op. |
Less Pain - on average, 2/3 of patients have little to no
pain after surgery. 1/3 have moderate pain post op. |
Less Pain - on average, most patients have any discomfort
after surgery. Some develop temporary bruising around lower
abdomen
|
| Potential
complications |
Possible chronic pain, numbness and infection. |
Possible postoperative adhesions and bowel injury |
Rare possibility of injury to major blood vessels |
| Infection Rates |
Highest |
Low |
Very Low |
| Bandage |
Bandage and drainage for 3 weeks after surgery |
Local area recover within 1-2 weeks after surgery |
Local area recover within 1-2 weeks after surgery |
| Healing |
Variable post op outcomes. In some incidences
patients suffer discomfort and movement
restrictions
|
Patients most experience a quick return to normal, with
little post op discomfort or movement restrictions |
Patients most experience a quick return to normal, with little
post op discomfort or movement restrictions |
| Activity
restrictions |
Most patients will return to normal activities within
3-6 weeks.
|
Most patients will return to normal activities within 1-2
weeks. |
Most patients will return to normal activities within 1-2 weeks.
|
| Recurrence
Rates |
Highest |
Low |
Very Low |
