What is the difference between minimally invasive and open hernia repair?

Minimally invasive hernia repair is a surgical procedure that relies only on three, small incisions to access the affected hernia site, thus reducing the pain felt after surgery.

Here to provide an expert insight into minimally invasive hernia repair, including how it compares to open hernia repair, is Mr Stelios Vakis, renowned consultant general and colorectal surgeon.

What is minimally invasive hernia repair?

Minimally invasive hernia repair generally involves making three incisions - one 1cm hole and two 0.5cm holes - usually in the abdominal wall to perform the operation. A thin camera is inserted through the 1cm hole, while surgical instruments are put through the two 0.5cm holes. The surgeon then manages the surgical instruments through the 0.5cm holes to fix the hernia. Thus, the surgeon is working at some distance from the hernia, but the surgical incision is much smaller compared to open surgery.

The advantage, especially when it comes to hernias, is that the same set of holes can be used to fix multiple hernias. Thus, if a patient has two hernias, then the same three holes can be used to fix both hernias, which is an advantage to the patient who has those hernias.

What are the differences between minimally invasive hernia repair and open hernia repair?

For a single side of hernia, the difference between performing open surgery or minimally invasive surgery lies in the position of the three incisions and the position of the surgical mesh (the support) that closes these incisions.

In minimally invasive surgery, the surgical mesh is placed inside of the abdomen, where it is fixed using either sutures or small plastic tacks that dissolve over time. In open surgery, the mesh is placed between the muscle layers at the front of the incision, which closes the incision off. The disadvantage of minimally invasive surgery is that general anaesthetic is definitely needed, whereas open surgery can be done under local aesthetic - even with a little bit of sedation.

Having said this, I would recommend minimally invasive surgery for any patient with hernias in two different areas of the body. This is because, with minimally invasive surgery, the two sides of hernias can be operated using the same three holes, therefore reducing the patient’s pain and being just as effective as with a single hernia.

What are the most common types of hernias repaired with minimally invasive surgery?

Commonly, femoral inguinal hernias are fixed with minimally invasive surgery. However, larger epigastric hernias and umbilical hernias can also be treated with minimally invasive surgery, and in some cases, incisional hernias as well. There is no real limitation to the type of hernia that can be repaired with minimally invasive surgery, as long as there is enough space in the abdomen to operate within it.

For this reason, minimally invasive surgery becomes much more difficult - especially with larger hernias - if a patient is particularly overweight and there is no space in the abdomen to work within it. In these scenarios, open surgery may be preferable.

Is hernia repair considered major surgery?

Most hernia operations are very common and relatively simple. In fact, I believe hernia repair is one of the commonest operations that general surgeons perform worldwide. Hernia repair is not major surgery, but there is a moderate risk involved just like with all operations.

How long does it take to recover from minimally invasive hernia surgery? When can I return to my daily activities?

Hernia surgery is normally carried out as a day-case procedure for the smaller hernias (usually groin hernias or belly button hernias). Most patients are able to drive within a couple of weeks.

If work does not involve heavy lifting (for example, with desk jobs) then patients are back to normal within two weeks. This is not to say that all the pain will have disappeared by then, but patients will be comfortable and safe enough to carry out their daily activities.

If, on the other hand, work involves the transportation of heavy goods that need to be lifted on and off a truck, for example, then patients are recommended to have at least four to six weeks off work to allow the surgical mesh to bed in better before putting it under test with heavy loads.

Mr Stelios Vakis is a highly skilled consultant general and colorectal surgeon with over 30 years’ experience.

If you require minimally invasive hernia repair and would like to consult your options with an expert, do not hesitate to book an appointment with Mr Vakis via his Top Doctors profile today.