LAPAROSCOPIC HERNIA REPAIR Please click here to see a YouTube video to help understand the procedure. Most of my patients receive laparoscopic repair unless contraindicated. I have extensive experience in the laparoscopic approach. A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually straightforward and involves reducing the hernia contents where they belong and then reinforcing the abdominal wall with a mesh. A hernia occurs when part of the abdominal contents contained in its lining (sac) pushes through a muscular defect. For a long time hernia have been repaired by an open technique involving a long incision, approximately 10cms, over the hernia in the groin. This incision extends through the muscle layer, and the sac of the hernia is mobilised, is removed or reduced and then the muscular defect is closed and reinforced with a mesh. The laparoscopic technique avoids a large skin incision and the muscular cut as well as apposing the defect under some tension. In this way post-operative pain is less and one can return to doing heavy physical activities and work earlier compared with the open technique. Technique: The operation is done within the space between the muscle and the inner most lining of the abdominal wall which is created by placing a special small insufflating balloon through a small incision just below the umbilicus. A special camera (laparoscope) is placed in this space. Two small incisions (5 mms) are made below the umbilicus to allow the passage of long instruments into the space created by the balloon. Once the hernia has been reduced, a polyester or polypropylene mesh is placed behind the defect and fixed in place. The mesh is held very firmly by the special self-gripping mesh or screws. An early return to full activity is permissible without fear of inducing hernia recurrence. This is usually achieved within seven days following surgery. Laparoscopic surgery is certainly more technically demanding than the traditional open approach. Provided attention is applied to detail, damage to the intestine or major blood vessels or nerves is avoided. Although foreign material (mesh) is left in the body, problems with infection around this has been minimal. Bowel obstruction has been described following the earlier method of laparoscopic hernia repair but the risk of this is considerably reduced when using the technique described above. The laparoscopic procedure is the preferred approach, particularly in bilateral groin as well in recurrent hernia. POST OPERATIVE INSTRUCTIONS ACTIVITY: Following a laparoscopic hernia repair there really are no activity restrictions but you have to be sensible in what sort of activities you take part in. Your body is going to dictate as to how much you can or can't do. The average time to full activities is between 1 - 2 weeks after surgery. DISCOMFORT: There is usually some degree of discomfort in the groin as well as the sugical wounds. There may be some discomfort and increased sensitivity in the testicle/scrotum on the side of the repair. This usually only lasts around 24-48 hours and usually settles very quickly. The testicular discomfort may remain for a few weeks. BRUISING: Is common but do not be alarmed and it will certainly fade within one to two weeks. Sometimes swelling in the groin may occur on the same side as the hernia. This usually represents fluid collection in the space where the hernia once was and this fluid is absorbed slowly over the next few weeks. ANALGESIA: Panadol (Paracetamol) and Ibuprofen/Arcoxia are usually needed and are often sufficient. WOUND CARE: You will have small dressings over the small wounds allowing you to take showers immediately following surgery. These dressings need to be removed in seven (7) days after surgery but leave the steristrips to fall out by themselves. POST OPERATIVE APPOINTMENT: Your clinic appointment is usually within two to four weeks from your surgery.

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

Conditions of the gut dealt with by general surgery include disorders of the oesophagus, stomach, small bowel, large bowel and anus. These range from complex conditions such as ulceration or cancer in the bowel through to fairly minor conditions such as haemorrhoids. Many of the more major conditions such as bowel cancer will require surgery, or sometimes treatment with medication, chemotherapy or radiotherapy. Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery.

Skin conditions dealt with by general surgery include lumps, tumours and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures. I am a Southern Cross Affiliated Provider for assessment and treatment of skin lesions (skin cancers and benign lumps). Some lesions may need surgery to be done under Local + IV sedation or General Anaesthesia and this will be discussed at the time of the consultation.

Vascular (blood vessel) disorders treated by general surgery include varicose veins, blockages and narrowings in the arteries or abnormal swellings of the arteries (aneurysm). The most common of these conditions facing the general surgeon is varicose veins. These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration. Vein stripping – the varicose veins are cut out and the veins that branch off them are tied off. The cuts (incisions) made in the skin are closed with sutures. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia. Phlebectomy – small cuts (incisions) are made in the leg and the varicose veins are pulled out with a tiny hook-like instrument. The cuts are closed with tape rather than sutures and, once healed, are almost invisible. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia.

This procedure is usually done as a day stay, under local anaesthesia in an office/procedure room setup. Patients are usually counselled in their first visit. The operation can proceed soon after or another appointment is made at a later date. The procedure takes on average 30 - 45 minutes and the patient is able return home. Follow up is done with phone contact or through the GP. Regular semen analysis is done to make sure it is all clear before stopping the use of contraception.