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A hernia is a common condition that can affect people of all ages. It is caused by a weakness in the abdominal wall, and when the patient coughs or strains a lump may appear. Patients often present with a small reducible lump in the groin, which can be tender. Surgery under regional, local or general anaesthesia is usually straightforward. A plastic mesh is often used to strengthen the repair. This open lattice work of plastic is rapidly incorporated into the tissues increasing the strength of the repair. Return to normal activities is usually rapid. It is usual to advise repairing the hernia before it strangulates or becomes irreducible.

Laparoscopic hernia repair

In the past most hernia were repaired using an ‘open’ approach; a 5-8cm cut is made in the groin and a mesh repair completed. An alternative approach is to perform a laparoscopic hernia repair. This involves three very small cuts (1 x 1 cm and 2 x 5mm) around the level of the umbilicus (tummy button). The operation is performed from the inside of the abdomen (tummy cavity). The hernia is confirmed and the sac reduced. A mesh is then tacked over the hernial orifice, so repairing the hernia from the inside. The laparoscopic approach has the advantage of a faster return to normal activities and is particularly good for bilateral (both sides) hernias and recurrent hernias. The disadvantage is the patient has to be put to sleep and the recurrence rate may be slightly higher than the conventional open approach in some situations.


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Before hernia repair   After mesh hernia repair

Before hernia repair After mesh hernia repair
  Hernia Mesh

Mesh in Place Hernia Mesh

Sportsmans Hernia

A sportsmans hernia is an important alternative cause of pain in the groin in active individuals. There is a potential weakness in the abdominal wall where a hernia would normally appear. The area affected is tender but a lump is not usually felt. Surgical repair usually gives excellent relief from the symptoms and return to normal sporting activities is fast.

Laparoscopic Cholecystectomy

The gallbladder lies just under the liver and normally collects bile. When food is eaten (particularly fatty foods) the gall bladder contracts. When the gallbladder contains stones this contraction can be painful. Occasionally the gallbladder gets infected (cholecystitis) and this also causes pain. The gallstones are usually diagnosed by ultrasound examination.

Gallstones can cause symptoms that are sufficiently bad for the patient to want to consider a surgical procedure to remove the gall bladder. This is usually performed with telescopes (laparoscopically), and can often be done either as a day case or with an overnight stay. Four access ports (2 X 10mm and 2 X 5mm) are used to insert the instruments. The gall bladder, the cystic duct and the cystic artery are carefully identified. The artery and duct is clamped with metal clips and then cut. The gallbladder is removed usually using a ‘retrieval bag’. A drain may be used. Return to normal activities is rapid.

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    Laparoscopic Equipment

  Laparoscopic Equipment

Open and Laparoscopic Splenectomy

Occasionally it is necessary to remove an abnormal spleen in a patient with a haematological condition. Sometimes a laparoscopic approach is possible.

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    A Grossly-Enlarged Spleen

  A Grossly-Enlarged Spleen

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