Patient Information

An inguinal hernia (a type of groin hernia) is a hernia within an anatomical structure called the inguinal canal. The inguinal canal is one of several points of weakness in an otherwise solid fibrous layer of the abdominal wall.

An inguinal hernia occurs when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the inguinal canal and often presents with a lump that can be felt in the groin.

Inguinal hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.
Inguinal hernias are the most common type of hernia and are more common in men than women.

It is not always necessary to repair inguinal hernias and the option of conservative (non-surgical) management may form part of the discussion with your surgeon. The decision to proceed with surgery will depend on hernia size, symptoms, gender considerations, co-morbidity (other medical conditions which a patient may have) and patient preference.

Options for surgical repair include open (an incision over the hernia), laparoscopic (key-hole) and robotic techniques.

Femoral hernia (a type of groin hernia) is a hernia within an anatomical structure called the femoral canal. The femoral canal is one of several points of weakness in an otherwise solid fibrous layer of the abdominal wall.

Femoral hernia occurs when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the femoral canal and often presents with a lump that can be felt in the groin.

Femoral hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.

Femoral hernias are more common in women than men. In most circumstances surgical management of femoral hernias is recommended to avoid potentially dangerous complications such as strangulation (where the blood supply to a section of bowel is cut off causing a surgical emergency) and obstruction (where the bowel becomes blocked causing a surgical emergency).

Options for surgical repair include open (an incision over the hernia), laparoscopic (key-hole) and robotic techniques.

Abdominal hernias can arise in natural points of weakness in the otherwise solid fibrous layer of the abdominal wall such as the umbilicus (belly button). They can also arise in scars caused by previous surgery (incisional hernia) or directly though the abdominal wall itself (epigastric and spigelian hernias).

Abdominal hernias occur when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the point of weakness and often present with a lump that can be felt beneath the skin.

Abdominal hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.

It is not always necessary to repair abdominal wall hernias and the option of conservative (non-surgical) management may form part of the discussion with your surgeon. The decision to proceed with surgery will depend on hernia size, symptoms, co-morbidity (other medical conditions which a patient may have) and patient preference.

Options for surgical repair include open (an incision over the hernia), laparoscopic (key-hole) and robotic techniques.

A recurrent hernia is a hernia that comes back in the same place after it was previously repaired. The core issue is that the abdominal wall never fully regains its original strength after a hernia repair, so the weak spot can reopen months or even years later. Not all recurrent hernias require surgical repair. Some will require complex abdominal wall reconstruction surgery, but for many robotic surgery is an excellent option given the precision and enhanced vision available during surgery.

Colonoscopy and Flexible Sigmoidoscopy

A colonoscopy is a procedure that examines the entire large bowel using a flexible camera, allowing doctors to diagnose conditions such as cancer, polyps, and inflammatory bowel disease. It also enables treatments like polyp removal and control of bleeding. A flexible sigmoidoscopy is similar but looks only at the lower part of the colon (rectum and sigmoid), making it quicker and usually performed without sedation. Both procedures are used to investigate symptoms such as rectal bleeding, changes in bowel habits, or suspected colitis, and both allow biopsies and minor treatments for polyps and haemorrhoids (piles).

The benefits of these tests include direct visual assessment of the bowel, early detection of cancer, and the ability to treat problems during the procedure. Risks are generally low but include bleeding—especially after polyp removal—and very rare perforation of the bowel. Colonoscopy carries slightly higher risks because it examines the whole colon, while sigmoidoscopy is less invasive but may miss disease higher up.

Robotic-Assisted Gallbladder Removal (Cholecystectomy)

What is the gallbladder?

The gallbladder is a small pouch located beneath the liver. Its role is to store bile, a digestive fluid produced by the liver that helps break down fats. Gallstones can form within the gallbladder and may cause pain, inflammation, infection, jaundice, or pancreatitis.

Gallstones do not always cause symptoms. If a stone blocks the normal flow of bile, it may cause severe or recurring upper abdominal pain, nausea or vomiting, indigestion, inflammation, infection, jaundice or pancreatitis. When symptoms or complications occur, surgery to remove the gallbladder is often recommended.

What is a robotic-assisted cholecystectomy?

A robotic-assisted cholecystectomy is a minimally invasive operation to remove the gallbladder using advanced robotic technology. The surgeon remains in complete control throughout the procedure, operating robotic instruments from a console within the operating theatre.
The robotic system provides a magnified, high-definition three-dimensional view and instruments with a wide range of movement. These features assist the surgeon with precise dissection, particularly in selected or technically complex cases.
What are the benefits of robotic surgery?

Robotic assistance gives the surgeon a three-dimensional view and instruments with a wide range of movement. These features may be helpful in selected or technically complex cases. However, robotic surgery is still keyhole surgery, and individual outcomes vary; it has not been shown to be better for every patient than conventional laparoscopic surgery.

• Small abdominal incisions
• Three-dimensional magnified vision for the surgeon
• Precise, flexible instrument movement
• Usually a same-day discharge or short hospital stay
• A gradual return to normal activities over the following days and weeks

Miss Richards will discuss why a robotic, conventional laparoscopic or open approach is recommended for you, including the expected benefits, uncertainties and alternatives.
Is robotic surgery right for everyone?
Most patients who require gallbladder removal may be suitable for a robotic-assisted approach. However, the most appropriate technique depends on several factors, including:

• Previous abdominal surgery
• The severity of gallbladder disease
• Current infection or inflammation
• General health and medical history

Miss Richards will discuss the best approach for your individual circumstances.

Preparing for your operation

Before surgery, the team will review your health, medicines and anaesthetic needs. Follow the instructions you are given about fasting and medicines, including blood-thinning medicines and diabetes treatments. Arrange for a responsible adult to take you home and, where advised, stay with you for the first 24 hours.

What happens during the operation?

The procedure is performed under a general anaesthetic, meaning you will be asleep throughout.

Small incisions are made in the abdomen. Carbon dioxide gas is used to create space, and a camera and robotic instruments are inserted. The surgeon controls every instrument movement from a console in the operating theatre. The cystic duct and artery are divided, the gallbladder is separated from the liver and removed, and the wounds are closed. The gallbladder is usually sent to the laboratory for examination.

The operation typically takes between one and two hours, although this may vary depending on the complexity of the case.

What are the risks?

As with any surgical procedure, there are potential risks. These include:

• Pain, bruising, bleeding or wound infection
• Anaesthetic complications, chest infection or blood clots in the legs or lungs
• Bile leakage or a collection of fluid, which may require drainage or another procedure
  Injury to the main bile duct, bowel, liver or blood vessels; this is uncommon but may require further surgery
• Stones remaining in, or later found within, the bile duct; an endoscopic procedure or further treatment may be needed
• Persistent abdominal symptoms, indigestion or loose stools after surgery
  A port-site hernia, prominent scarring, numbness or long-lasting pain
• Conversion to conventional laparoscopic or open surgery if this is the safest option
• Very rarely, a life-threatening complication or death

Miss Richards will discuss these risks with you before surgery.

The likelihood of a complication depends on your health and the complexity of the operation. Ask Miss Richards if you would like the risks explained using figures relevant to your circumstances.

Recovery after surgery

Most patients return home on the same day or after an overnight stay.
You can usually:

• Walk regularly from the day of surgery and increase activity gradually
• Take pain relief as advised and follow the wound-care instructions given at discharge
• Eat a normal, balanced diet; smaller meals may be easier for the first few days
• Return to work after about one to two weeks if you feel ready; heavy or physically demanding work may require longer
• Do not drive until you can control the vehicle and perform an emergency stop without pain, and check your motor insurance requirements
• Avoid strenuous exercise and heavy lifting until comfortable and follow any individual advice from your surgical team

You can live a normal, healthy life without a gallbladder. Your liver continues to make bile, but it flows directly into the small intestine rather than being stored. Some people experience temporary bloating or loose stools, particularly after fatty foods; this usually improves over the following weeks. If symptoms persist, seek advice from your surgical team or GP.

Your treatment decision

The decision to have surgery is yours. Alternatives may include continued observation and symptom management in selected circumstances, or conventional laparoscopic surgery. Medicines do not reliably remove established gallstones, and symptoms or complications may recur if the gallbladder remains in place. Miss Richards will explain the options that are appropriate for you.
Your surgical team will guide you through preparation, consent, the operation and recovery. Please ask if anything in this leaflet is unclear or if you have questions about your individual care.