A hernia occurs when there is an opening or weakness in the muscles of the abdomen. This happens most commonly in the groin (where it's called an inguinal hernia), because there is a natural weakness there, where some blood vessels (and, in men, the vas deferens) pass through the muscles. The hernia defect allows your insides (fatty tissues or intestines which are in the abdomen) to bulge through the opening; this is the lump, or hernia, that you can feel.

In the usual inguinal hernia repair, an incision is made under local anesthesia, and the muscles are repaired with stitches and a plastic mesh patch. There is some discomfort for a week or two, and activity is limited for several weeks. The operation is very successful; only about 5% of hernias should recur. It is also very safe.

In laparoscopic inguinal hernia repair, the operation is done under general anesthesia. A small incision is made below the belly button. A video telescope is then inserted behind the muscles of the abdomen, allowing the surgeon to see the hernia defect from the inside on a TV screen. The hernia opening is then "patched" from the inside with a piece of plastic mesh. The muscles are not stitched together; the plastic mesh replaces the muscle. The operation has been successful, but it has only been done since about 1990. It is not as safe as the standard procedure, because it requires general anesthesia, and because of the slight risk of injury to the intestines during the operation. However, the advantages are that there is usually less pain after the operation, and that you can resume normal activities, including lifting, without waiting several weeks.

In some situations, there may be medical reasons to prefer one type of hernia repair over another. For example, in someone with asthma, it may not be safe to undergo general anesthesia, and therefore a standard hernia repair under local anesthesia would be used. But in most people, either option is reasonable. In this case, it is up to you (the patient) to make the choice.

If you think that the benefits of laparoscopic repair (less pain and an earlier return to normal activity) outweigh the additional risks of the procedure (general anesthesia, possible intestine injury, and less certain long-term results), then you may be a good candidate for this new procedure.

The operation will be done as an outpatient. It takes about an hour to repair one hernia. After the operation, you will be kept in the recovery room for two hours or so. There will be some discomfort in the abdomen, and possibly some shoulder pain as well. Once you go home, you should take it easy. You will probably need pain medication for two or three days. There may be some swelling and bruising in the groin area, and in the scrotum and penis in men. The risks of the operation, besides the usual risks of anesthesia, include injury to the intestine, to the vas deferens, and to the nerves or blood vessels in the groin area. The repair may not be sucessful, and an open operation may be necessary immediately or subsequently to fix it. There may be recurrence of the hernia in the future. Pain in the groin area is also sometimes a problem, and can be longlasting. It is probably due to scarring around the nerves in that area which develops after the operation.

PREOPERATIVE INSTRUCTIONS:
1. Do not take aspirin, bufferin, anacin, advil, nuprin, or similar medications within a week of the operation. Tylenol (acetaminophen) is OK.
2. If you take any other medications, check with us about taking them before the operation. In most cases, we will want you to continue.
3. Keep your preoperative appointment at the hospital.
4. Do not eat or drink anything (except for your medications, which you may take with a sip of water) after midnight before the operation.

POSTOPERATIVE INSTRUCTIONS:
1. Go right home and take it easy. Any activity which does not cause pain is OK.
2. There is normally some discomfort in the abdomen, especially near the incisions in the belly button and on the sides of the abdomen. There may also be some soreness in the shoulders, which should get better after a day or two. There is also normally some swelling where the hernia was, and men may have some swelling and bruising of the penis and scrotum.
3. You may shower. Keep band-aids over the incisions for a few days.
4. Make an appointment to see the surgeon about a week after the operation.
5. Call immediately if abdominal pain gets worse, or you develop fever or persistent vomiting. Call if you have any questions or problems. There is always someone to return your call.