|
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
[ top ] |
