Abdominal wall hernias are the protrusion of one or more intra-abdominal organs through a soft spot in the abdominal wall. They are one of the most common surgical conditions and one of the most common causes of admission to a surgical clinic.
Factors that contribute to the creation of hernias are:
- Poor collagen quality
- Obesity
- Genetic factors
- Smoking
- Intense and prolonged exercise
- Previous surgeries
There are various types of hernias depending on their location and etiology. The most common types are inguinal hernia, umbilical hernia, epigastric hernia, femoral hernia and postoperative hernia. Rarer forms of hernia are thyroid hernia, Spiegel’s hernia, parastomal hernias, lumbar hernias, etc.
In the past, the treatment of hernias consisted of closing the gap with sutures, which resulted in intense postoperative pain for the patient and a fairly high rate of recurrence. From the 1980s onwards, the use of meshes was introduced in the repair of hernias and the “tension-free technique” was established. This brought about a drastic reduction in postoperative pain, but also in recurrence rates. Nowadays, the technological development of meshes has led to their improvement, so that today there are many types of meshes that can be used depending on the situation (semi-absorbable, synthetic, with collagen, double-sided, with large or small pores). The fixation of the meshes to the abdominal wall can be done with sutures, metal clips, glue, while in some cases the mesh is not fixed and is held in place by the adjacent tissues.
Laparoscopic surgery also has its place in the treatment of hernias, with the result that almost all hernias can be treated laparoscopically. This results in better cosmetic results for the patient, less postoperative pain, and a faster return to daily activities.
In general, any adult patient who can receive general anesthesia and does not have blood clotting disorders may be a candidate for laparoscopic hernia repair. Ideal candidates are patients with recurrent hernia who initially underwent open surgery.
Especially in inguinal hernias, which are the most common form of hernia, there are 2 forms of laparoscopic access:
- Transabdominal preperitoneal access (TAPP)
- Totally extraperitoneal preperitoneal access (TEP)
Indications for laparoscopic inguinal hernia repair are:
- Bilateral inguinal hernia
- Relapse
- Inguinal hernia in athletes or patients with heavy manual labor
- Inguinal hernia in women
