Laparoscopic
Hernia Repair
Approximately 600,000
hernia repair operations are performed
annually in the United States. Most
are performed by the conventional
"open" method and some laparoscopically.
Laparoscopic Hernia
Repair is a recent technique to fix
tears in the abdominal wall (muscle)
using very small incisions, and a
patch (mesh). It may offer quicker
return to work and normal activities
with decreased pain for some patients.
What is a hernia?
When a hernia occurs,
it means the inside layers of the
abdominal muscle have weakened, resulting
in a bulge or tear. In the same way
that an inner tube pushes through
a damaged tire, the inner lining of
the abdomen pushes through the weakened
area of the abdominal wall to form
a small balloon-like sac. This can
allow a loop of intestine or abdominal
tissue to push into the sac. The hernia
can cause severe pain and other potentially
serious problems that could require
emergency surgery. Both men and women
can get a hernia. You may be born
with a hernia (congenital) or develop
one over time. A hernia does not get
better over time, nor will it go away
by itself.
How do I know if
I have a hernia?
The common areas
where hernias occur are in the groin
(inguinal), belly button (umbilical)
and the site of a previous operation
(incisional). It is usually easy to
recognize a hernia. You may notice
a bulge under the skin. You may feel
pain when you lift heavy objects,
cough, strain during urination or
bowel movements or during prolonged
standing or sitting. The pain may
be sharp and immediate or a dull ache
that gets worse toward the end of
the day.
Severe, continuous
pain, redness and tenderness are signs
that the hernia may be entrapped or
strangulated. These symptoms are cause
for concern and immediate contact
of your physician or surgeon.
Why do people get
hernias?
The wall of the
abdomen has natural areas of potential
weakness. Hernias can develop at these
or other areas due to heavy strain
on the abdominal wall, aging, injury,
an old incision or a weakness present
from birth. Anyone can get a hernia
at any age. Most hernias in children
are congenital. In adults, a natural
weakness or strain from heavy lifting,
persistent coughing, difficulty with
bowel movements or urination can cause
the abdominal wall to weaken or separate.
What are the treatment
options?
There are few options
available for a patient who has a
hernia.
Use of a truss (supportive device)
is rarely prescribed as it is usually
ineffective.
Most hernias require
a surgical procedure.
Surgical procedures
are now done in one of two fashions.
I. The first, or traditional approach,
is done from the outside through an
incision in the groin or the area
of the hernia. The incision will extend
through the skin, subcutaneous fat,
and allow the surgeon to get to the
level of the defect. The surgeon may
choose to use a small piece of surgical
mesh to repair the defect or hole.
This technique is usually done with
a local anesthetic and sedation but
may be performed using a spinal or
general anesthetic. II. The second
approach is a laparoscopic hernia
repair. In this approach, a laparoscope
(a tiny telescope) connected to a
special camera is inserted through
a canula, a small hollow tube, allowing
the surgeon to view the hernia and
surrounding tissue on a video screen.
Other canulas are
inserted which allow the surgeon to
work "inside." The hernia
is repaired from behind the abdominal
wall. A small piece of surgical mesh
or screen is fixed over the hernia
defect and held in place with small
surgical staples. The operation is
through 3 very small incisions (less
than ¼%) and is performed with
general anesthesia. This technique
may allow the patient to enjoy a shorter
recovery time and experience less
post-operative discomfort.
Is everyone a candidate
for laparoscopic hernia repair?
Only after a thorough
examination can your surgeon determine
whether laparoscopic hernia repair
is right for you. The procedure may
not be best for some patients who
have had previous abdominal surgery
or underlying medical conditions.
What are the complications
of laparoscopic hernia repair?
Any operation may
be associated with complications.
The primary complications of any operation
are bleeding and infection, which
are uncommon with laparoscopic hernia
repair.
There is a slight
risk of injury to the urinary bladder,
the intestines, blood vessels, nerves
or the sperm tube going to the testicle
in males.
Difficulty urinating
after surgery is not unusual and may
require a temporary tube into the
urinary bladder.
Any time a hernia
is repaired it can come back. This
long-term recurrence rates at this
point appear to be equal to or better
than the open approach. Your surgeon
will help you decide if the risks
of laparoscopic hernia repair are
less than the risks of leaving the
condition untreated.
What happens if the
operation cannot be performed by the
laparoscopic method?
In a small number
of patients the laparoscopic method
is not feasible because of the inability
to visualize or handle the organs
effectively. Factors that may increase
the possibility of converting to the
"open" procedure may include
obesity, a history of prior abdominal
surgery causing dense scar tissue,
or bleeding problems during the operation.
The decision to perform the open procedure
is a judgment decision made by your
surgeon either before or during the
actual operation. The decision to
convert to an open procedure is strictly
based on patient safety.
What preparation
is required?
Most hernia operations
are performed on an outpatient basis,
meaning the patient will go home on
the same day that the operation is
performed.
You should refrain
from eating or drinking after midnight
on the night before your operation.
You should shower
the night before or the morning of
the operation.
If you have difficulties
moving your bowels, an enema or similar
preparation can be used after consulting
with your surgeon.
Some preoperative
testing may be required depending
on your medical condition and the
type of anesthesia needed for your
operation.
If you take medication
on a daily basis, discuss this with
your surgeon as he may want you to
take some of your medications on the
morning of surgery with a sip of water.
If you take aspirin, blood thinners
or arthritis medication you need to
discuss with your surgeon the proper
timing of discontinuing these medications
before your operation.
What should I Expect
after surgery?
Following the operation,
you will be transferred to the recovery
room where you will be monitored carefully
until you are fully awake.
Once you are awake
and able to walk, you will be discharged.
With any hernia
operation, you can expect some soreness.
This will be mostly during the first
24 to 48 hours.
You are encouraged
to be up and about the day after surgery.
If you begin to
have fever, chills, vomiting, are
unable to urinate, or experience drainage
from your incisions, you should call
your surgeon immediately.
With laparoscopic
hernia repair, you will probably be
able to get back to your normal activities
within a short amount of time. These
activities include showering, driving,
walking up stairs, lifting, work and
sexual intercourse.
If you have prolonged
soreness and are getting no relief
from the prescribed pain medication,
you should notify your surgeon. You
should call and schedule a follow-up
appointment within 10 days after your
operation.
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