Part of the TeachMe Series

Consent: Laparoscopic Inguinal Hernia Repair

Not yet rated
based on ratings

Last updated: March 12, 2021
Revisions: 5

Last updated: March 12, 2021
Revisions: 5

format_list_bulletedContents add remove

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

There are several types of hernia, the most common being inguinal, femoral, and umbilical. Repairs can be done both open or laparoscopically, especially for inguinal hernia. The mesh used during the repair is secure in place using tacks.

Laparoscopic procedures have been shown to reduce post-operative pain and allow for faster recovery and return to work. For inguinal cases, laparoscopic repair may also be favoured in patients with bilateral or recurrent inguinal hernia.

The two commonly employed techniques for laparoscopic inguinal hernia repair are TEP (Totally ExtraPeritoneal) and TAPP (TransAbdominal PrePeritoneal), depending on the layers involved and opened during the repair (Fig. 1).

Figure 1 – Layers involved during a TEP and TAPP inguinal hernia repair

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Injury can occur to inferior epigastric vessels (especially with a TEP repair) or external iliac/ femoral vessels Ensure careful deployment of tacks when securing the mesh
Injury to surrounding structures including bowel, bladder and ureter, liver, spermatic cord Contents of the hernial sac may include these structures
Bowel resection Incarcerated hernias may contain ischaemic bowel; if the bowel is not viable it must be resected.
Conversion to open In some cases anatomy may be difficult and it is safer to proceed to an open anterior inguinal hernia repair.

In TEP repairs the peritoneum may be breached and the decision made to convert to TAPP repair.

Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation

 

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain Use of laparoscopic surgery, compared to open surgery, will limit post-operative pain
Bleeding/ haematoma There is a small chance of bleeding and bruising in the abdomen post-surgery Haematoma or seroma formation are usually self-limited due to the tamponade of the peritoneum
Infection Superficial wound infection is possible. An infected mesh is a fortunately rare but serious complication, as would be revision of wound Peri-operative antibiotics will reduce the risk of wound infections
Scarring Laparoscopic surgery will minimise this risk
Altered sensation Damage to ilioinguinal and/or genitofemoral nerve
Seroma A swelling of lymphatic fluid may occur in redundant subcutaneous space following surgery
Testicular Atrophy Damage to the blood supply to the testicle can occur in groin hernia repair, often due to venous thrombosis rather than arterial injury Identify and avoid damage to the spermatic cord and associated vessels
Scrotal swelling/ hydrocoele Damage to venous/ lymphatic drainage during dissection
Blood Clots The patient will be given anti-embolism stockings and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

 

Late

Complication Description of Complication Potential Ways to Reduce Risk
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure, although this is uncommon (especially in TEP repair)
Recurrence There is always a potential for further surgery due to recurrence of the hernia. For inguinal hernia it is around 1% at 5 years. Request the patient avoids strenuous activity for a few weeks post-operatively
TeachMeSurgery