Laparoscopic Herniorrhaphy

What you should know

• Laparoscopic herniorrhaphy, also known as transabdominal preperitoneal (TAPP) repair, is surgery to repair a hernia. A hernia may occur when the muscle layers in your abdomen (stomach) weaken. The weakened muscle layers allow your tissues or organs to push through. When this happens, a bulge or mass (lump) may be seen or felt under your skin. Hernias often occur in your inguinal (groin) area. A hernia may also occur near your genital area (between your inner legs), or upper thigh. Hernias may also form in the front of your abdomen, or in areas of past surgical incisions (cuts).
  
  
• During this surgery, a special tool called a laparoscope is used. A laparoscope is a long metal tube with a light and camera on the end. The laparoscope will be inserted into your peritoneal cavity (the space in your abdomen containing organs). The laparoscope will allow your caregiver to see your hernia. You may have a hernia in one or both sides of your groin in need of repair. Laparoscopic surgery to fix your hernia may strengthen your abdominal muscles, remove your hernia bulge, and decrease your pain.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• You may be allergic to the anesthesia used during your surgery. You may also bleed more than expected during your surgery. During your surgery you may have injuries to your nerves, blood vessels or abdominal organs. The contents of your bowel may spill into your abdominal space and cause a very bad infection. In some cases, a TAPP hernia repair may need to be changed into an open hernia repair surgery. An open surgery means larger and deeper incisions will be made, which will take longer to heal. You may have shoulder and chest pain from the gas used during your surgery.
  
  
• You may have bruising, seroma (collection of fluid), swelling, or infection at your surgery site. After surgery, you may have trouble emptying your bladder. There is a risk of getting a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• You may have chronic (lasting) pain or numbness in your groin area for months or years after your surgery. You may need to have another surgery if your condition returns or occurs in a different area. If you do not have the surgery, your pain or discomfort may increase. Your soft tissue or bowels may become trapped in your abnormal opening. When tissues and organs are trapped they may become necrotic (tissue death). Trapped necrotic tissue and organs may be life-threatening. Talk to your caregiver if you have questions about your condition, surgery, or care.

Getting Ready

The week before your surgery:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Tell your caregiver if you are allergic to any medicine. If you are taking anticoagulation medicine, you may need to stop taking it a few days before surgery. You may also need to stop using aspirin or any other prescribed or over-the-counter medicines. Tell your caregiver if you use any herbs or food supplements. Bring your medicine bottles or a list of your medicines when you see your caregiver.
  
  
• You may need an abdominal ultrasound or computed tomography (CT) scan. This is to help your caregiver learn more about your condition. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.

The night before your surgery:

• Ask your caregiver about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the date, time, and location of your surgery.
  
  
• You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken on a stretcher to the room where your surgery will be done. You will be placed lying on your back with your feet slightly higher than your head. Medicine called anesthesia will be given to keep you asleep and free from pain during your surgery. Your abdomen and groin area will be cleaned. Your caregiver will make 3 to 4 small incisions (cuts) around your groin area and into your peritoneal cavity. The laparoscope and other special surgery tools will be inserted through the incisions. Carbon dioxide gas may be used to inflate (make larger) your abdominal cavity. The gas will allow your caregiver to better see the area in need of repair.
  
  
• The weakened muscles in your groin will be checked through the scope. Your caregiver will remove your hernia or push it back into its normal space. A mesh patch will be placed over the area of the hernia and stapled or tacked in place. Your peritoneum (inner tissue lining of your abdomen) will then be closed over the mesh with staples or stitches. The carbon dioxide gas and surgery tools will be removed. Your incisions will be closed with stitches and covered with a bandage. The bandage will help keep your incisions clean and dry, and help to prevent infection.

After your surgery:

You will be taken to a room where you will rest until you are fully awake. Once your caregivers see that you are okay, you may be able to go home. If your caregiver wants you to stay in the hospital, you will be taken to your room. Do not try to get out of bed until your caregiver says it is okay. An ultrasound test may be done after your surgery to check the repair.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You get sick (a cold or the flu).
  
  
• You have a fever (high body temperature).
  
  
• Your groin is swollen, painful or feels warm to the touch.

Seek Care Immediately if

• You have an upset stomach or start to throw up.
  
  
• Your hernia area suddenly becomes very painful.
  
  
• Your lump increases in size, or you are not able to gently push it back into your abdomen.

Learn more about Laparoscopic Herniorrhaphy (Precare)