Laparoscopic Hernia Repair: A brief information

Laparoscopic Inguinal Hernia Repair
WHAT IS A HERNIA?
• An abdominal hernia is an abnormal protrusion of an abdominal organ through an abnormal defect in the wall of the abdominal wall.. 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 like intestinal obstruction/gangrene that could require emergency surgery.




1:abdominal wall;2:intestines,3:hernia
• Both men and women can get a hernia.
• You may be born with a hernia (congenital) or develop one over time (acquired).
• A hernia does not get better over time, nor will it go away by itself (only surgical cure is there there is no role of medications).
What are the symptoms?
• The common areas where hernias occur are in the groin (inguinal), umbilicus (umbilical), and the site of a previous operation (incisional).


• 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 hernia usually protrudes during strenuous activity and settles back in abdomen during rest. But sometimes it may not go back(persistent swelling).
• The patient may have dull ache or sharp shooting pain.
• Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. This is a sign of emergency .
WHAT CAUSES A HERNIA?
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(congenital hernia).



Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting(sportsmen), persistent coughing(ASTHMA/COPD patients), constipation or difficulty in urination(prostatic enlargement ) can precipitate the hernia.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC HERNIA REPAIR?
Laparoscopic Hernia Repair is a technique which covers the defect in the parietes using key holes, telescopes and a mesh(prolene mesh/biodegradable mesh). If may offer a quicker return to work and normal activities with a decreased pain for some patients.
ARE YOU FIT FOR LAPAROSCOPIC HERNIA REPAIR?
As the laparoscopy involves insufflations of carbon dioxide gas in abdomen and general anaesthesia ; general fitness is must.Those patients who are not candidates for the laparoscpy can be offered open repair under local inguinal block or spinal/epidural anaesthesia.
Procedure prior to Laparoscopy:

• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
• Drugs such as antiplatelet agents will need to be stopped temporarily for several days to a week prior to surgery( with the consultation with In-house physician).
• You may be administered enema in night time before the day of the surgery.
HOW IS THE PROCEDURE PERFORMED?
I. The open approach is done from the outside with 5-7 cm incision in the groin. 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 as shown in figure(Lichensteins tension free hernia repair).



II. The laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.
Other tubes are inserted which allow your surgeon to work "inside." Three or four small incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect. This operation is usually performed with general anesthesia





WHAT HAPPENS IF THE OPERATION CANNOT BE COMPLETED BY THE LAPAROSCOPY?
In a small number of patients the laparoscopic method cannot be performed. The factors which may cause difficulty in progress are obesity,presence of scar tissue because of previous surgeries,difficulty in dissection because of incarcerated bowels etc..
When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.
WHAT SHOULD I EXPECT AFTER SURGERY?
• Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
• You will be transferred to your ward in the evening and allowed sips of fluids in the same day usually.The next day usually the normal diet is started.
• With laparoscopic hernia repair, you will probably be able to get back to your normal activities within 3-4 days. These activities include showering, driving, lifting, working and sexual intercourse.
WHAT COMPLICATIONS CAN OCCUR?
• Few complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
• There is a slight risk of injury adjacent organs like urinary bladder, the intestines, blood vessels, nerves.
• Difficulty urinating after surgery is not unusual and may require a catheter into the urinary bladder for as long as one week(especially in patients with prostatic enlargement; we usually do both prostate surgery and hernia repair simultaneously in cases where the prostate is the precipitating factor) .
• Recurrence can occur.(Although with the mesh repair it is less common still it is a rare possibility).
WHEN TO CALL AN EMERGENCY

• Persistent fever over 101 degrees F (39 C)
• Bleeding/Local groin swelling
• Persistent Pain/nausea or vomiting
• Inability to urinate
• Pus discharge from any incision/Redness surrounding any of your incisions that is worsening or getting bigger
• Abdominal distension