Keyhole Operations

Costs

Costs vary depending on your health insurance. The funding provided by Medicare and Health Funds for this revolutionary operation is no higher than for the old non-keyhole method. Consequently there will be out of pocket costs involved and the following information explains what to expect. Unfortunately LapSurgery Australia do not operate in public hospitals but should you wish to pay to have your surgery done in a private hospital an estimate of costs can be provided following a consultation with one of our surgeons.

The Surgeon

LapSurgery Australia surgeons charge through the "Known Gap" scheme for a majority of Health Funds. This means that you pay a co-payment to the surgeon before the operation and the balance of the surgeon's account is sent directly to the Health Fund. If you are with one of the few Health Funds that do not allow co-payments, your out of pocket costs will be higher. If you have no private insurance the cost will be substantial and an estimate will be given to you after seeing a surgeon.

Assistant Surgeon & Anaesthetist

There will be charges from both the Assistant Surgeon and Anaesthetist. Accounts for these services vary and are independent of LapSurgery Australia. We are able to advise you of the individuals providing these services once a date has been scheduled for your surgery.

The Hospital

Out of pocket costs for the Hospital vary depending on your Health Fund, level of cover, excess etc. For an accurate cost, please refer to your Health Fund or the Hospital.

The Medicare item number you will need to quote is 30609.

It is YOUR RESPONSIBILITY to check that your health insurance is up to date and whether there will be any excess charges. LapSurgery Australia cannot check this for you.

Other Costs

The normal services required for your operation are listed above. Occasionally patients require additional medical care and may incur charges for pathology, radiology and other specialists.

FAQ

What is a hernia?

A hernia is a protrusion of an organ or body part through the wall of a cavity in which it is normally enclosed. What this means, in the case of groin hernia, is that part of the abdominal contents, either bowel or fatty tissue, protrudes through the abdominal wall at the inguinal or femoral canal and comes out just below the skin. In males, a large hernia can descend into the scrotum.

The inguinal canal is an oblique passage through the abdominal wall which, in the male, transmits the artery and vein to the testicle and the vas deferens. In the female, only the round ligament of the uterus goes through the inguinal canal and this is perhaps why inguinal hernia is less common in women. The inguinal canal is one of several weak spots in the abdominal wall where a hernia can occur.

How do I know if I have a groin hernia?

The commonest symptom of a hernia is the presence of a lump in the groin. Sometimes hernias can be painful, but small hernias may not be noticed initially by the patient and are sometimes found unexpectedly at a routine examination. Often the lump is more prominent at the end of the day, disappears when lying down and may not be apparent after a night's sleep.

In rare instances, the first presentation of a hernia is a very painful lump in the groin which does not go away when lying down and may be associated with generalised pain across the abdomen and vomiting. This is caused by strangulation and should this happen it is an extreme emergency and immediate medical attention must be sought.

What tests are available to diagnose a hernia

For the vast majority of patients, a hernia is diagnosed by a simple physical examination from your general practitioner or specialist. In some cases ultrasound examination of the groin is used but most surgeons are sceptical of the accuracy of ultrasound examination for hernia. The results of ultrasound examination must be interpreted in conjunction with a physical examination by your general practitioner or specialist surgeon.

What causes a hernia?

Hernias which occur in childhood or adolescence are probably congenital. In adults a hernia is usually acquired. Although not well proven, it is thought that occupations involving heavy lifting or manual work increase the chance of developing a hernia. Cigarette smoking, chronic constipation, obesity, prostate disease and chronic coughing are also thought to predispose to hernia formation. In many patients none of these factors is present and the development of a hernia is thought to be related to the fact that the inguinal and femoral canals are natural areas of weakness in the body wall.

Why can't I just wear a truss?

A truss is a type of belt with padding which goes over the inguinal canal to keep the hernia from coming out during normal activity. They are generally uncomfortable, will not cure the hernia and do not prevent strangulation. We strongly recommend against the use of a truss except in those very rare people who are too sick to undergo operative repair of the hernia. A truss must NEVER be used on a femoral hernia.

What is keyhole surgery for hernia?

Laparoscopic or keyhole surgery for hernias has evolved over the last 10 years. There have been several different ways of performing keyhole surgery for hernia, but the worldwide trend is toward the totally extra peritoneal (TEP) repair which is what we at LapSurgery Australia perform. The advantage of this method is that the peritoneum (the cavity containing the bowels) is not entered. A space is made by inflating a balloon between the lining of the peritoneal cavity and the groin muscles and inflating the space with CO2 gas to create a working space.

The standard (non-keyhole) operation involves a large incision in the groin (or both groins if there are hernias present on both sides), finding the hernia and patching the defect with polypropylene mesh.

In the keyhole operation a 1.5 cm (3/4 inch) incision is made just below the umbilicus (bellybutton) and two further tiny incisions are placed between the umbilicus and the pubis. No further incisions are required even if there are hernias in both groins. The hernia is identified and the defect repaired with mesh as in the open (non-keyhole) operation.

Should everyone have a keyhole operation for hernia?

No. There are a number of reasons why an individual may be better off with the non-keyhole operation:

1. Very large hernias may not be suitable for keyhole repair.
2. Patients with previous lower abdominal surgery may not be suitable.
3. Patients unable to tolerate a general anaesthetic are not suitable.
4. Patients who do not have a need for quick recovery may be better off with the less complex non-keyhole operation.
5. Patients without private health cover may find the extra hospital costs of the keyhole operation are not justified.

What hospitals do LapSurgery Australia surgeons attend?
Keyhole hernia surgery can be performed at:

• The Valley Private, Mulgrave
• Knox Private, Wantirna
• The Bays, Mornington
• St John of God Berwick, Berwick

Surgical Risks

A number of factors have been proposed as being disadvantages of the keyhole operation and these will be discussed with you at your consultation with your surgeon. All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and even death.  If you have other health problems such as heart or lung problems, diabetes, smoking or excess weight the general risks of surgery are increased.

Longer Operation

The operation takes longer. This is certainly true when a surgeon is learning how to do this quite complex procedure, but the experience of surgeons at LapSurgery Australia shows that once the keyhole technique is mastered, there is very little difference in time taken between the keyhole and non-keyhole operation.

Serious Complications

There is a higher incidence of serious complications. This is true if the raw data published in the medical literature is examined. However, the same can be said of a number of new operations introduced over the last few years such as keyhole gallbladder surgery. As experience with these new techniques is gained, the complication rate declines to minimal levels. LapSurgery Australia surgeons have encountered no major complications specific to the keyhole operation.

Infection or Rejection

In the exceptionally rare situation of a complication of the mesh such as infection or mesh rejection, the mesh is more difficult to remove than when it is on the outside of the muscles as with the non-keyhole operation. LapSurgery Australia accepts that this may be a disadvantage of the keyhole operation, but removal of mesh from any part of the body at any time can be extremely difficult and result in complications. Estimates of the chance of mesh infection or rejection range from 1 per thousand cases to 1 per 3000 cases.

Surgical Benefits

There are three main advantages:

Quicker Recovery

The small incisions result in less pain and earlier return to work, especially when hernias are present on both sides.

Piece of mind

The positioning of the mesh on the inside of the defect is mechanically better than when placed on the outside as in the non-keyhole operation.

Less Risk

By positioning the mesh on the inside of the defect, the very sensitive nerves in the inguinal canal are not damaged or irritated by the mesh as can occur in the non-keyhole operation.

Post Operative Instructions

For instructions relating to this operation, please visit the Patient Care Instructions page.