Approximately 600,000 hernia repair operations are performed annually in the United States. Many are performed by the conventional "open" method. Laparoscopic Hernia Repair is a recent technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). It may offer quicker return to work and normal activities with decreased pain for some patients.
When a hernia occurs, it means the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. The inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.

• Both men and women can get a hernia.
• You may be born with a hernia (congenital) or develop one over time.
• A hernia does not get better over time, nor will it go away by itself.

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical) and the site of a previous operation (incisional). It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements or during prolonged standing or sitting. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.

Surgical procedures are now done in one of two fashions:

1. The first, or traditional approach, is done from the outside through an incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
2. The second approach is a laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a canula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other canulas are inserted which allow your surgeon to work "inside." The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh or screen is fixed over the hernia defect and held in place with small surgical staples. 3 or 4 quarter inch incisions are usually necessary. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.

This technique may allow the patient to enjoy a shorter recovery time and experience less post-operative discomfort. In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. Factors that may increase the possibility of converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.