Laparoscopic Inguinal Hernia Repair

 

 

A hernia occurs when part of an internal organ (usually the small intestine) protrudes through a weak point or tear in the peritoneum, the thin muscular wall holding the abdominal organs in place resulting in a bulge. In an inguinal hernia, abdominal fat or a loop of small intestine enters the inguinal canal, a tubular passage through the lower layers of the abdominal wall. In men, inguinal hernias typically develop in the groin area near the scrotum, on one or both (double hernia) sides. 

 

A direct inguinal hernia forms a bulge in the groin area. An indirect hernia descends into the scrotum. Inguinal hernias occur predominently in men. If an Inguinal hernias become incarcerated and then strangulated, it can restrict blood supply to the small bowel creating a medical emergency.

 

Description of Procedure

 

A laparoscopic hernia repair is a type of minimally invasive surgery, which small incisions are first made in the abdominal wall and the abdomen inflated with carbon dioxide. A laparoscope (a thin, tube-like instrument with a small video camera) and miniature surgical instruments are then passed through the incisions. Using an external monitor display, the surgeon pushes the herniated intestine back into place and repairs the hernia tear. Mesh is then placed over the area to reinforce the abdominal wall. The procedure is performed under general anesthesia.

 

Advantages for Patients

 

A minimally invasive laparoscopic hernia repair offers numerous advantages to patients:

 

• Less post-operative pain

• Faster recovery from surgery

• Patients can often go home the same day as the surgery or within 24 hours

• A more rapid return to work and normal activities 

 

Potential Complications

 

Surgery to repair an inguinal hernia is generally safe and complications are uncommon. Knowing possible risks allows patients to report postoperative symptoms to their doctor as soon as they occur.

 

• Risk of general anesthesia. Before surgery, the anesthesiologist-a doctor who administers anesthesia-reviews the risks of anesthesia with the patient and asks about medical history and allergies to medications. Complications most likely occur in older people and those with other medical conditions. Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs.

  Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots.

• Hernia recurrence. A hernia can recur up to several years after repair. Recurrence is the most common complication of inguinal hernia repair, causing patients to undergo a second operation.

• Bleeding. Bleeding inside the incision is another complication of inguinal hernia repair. It can cause severe swelling and bluish discoloration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 percent of patients.

• Wound infection. The risk of wound infection is small-less than 2 percent-and is more likely to occur in older adults and people who undergo more complex hernia repair.2 The person may experience a fever, discharge from the incision, and redness, swelling, or tenderness around the incision. Postoperative infection requires antibiotics and, occasionally, another procedure requiring local anesthesia to make a small opening in the incision and drain the infection.

• Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Medicine may be injected in the area if the pain continues.

• Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys, nerves and blood vessels leading to the legs, internal female organs, and vas deferens-the tube that carries sperm-can occur during hernia surgery and may lead to more operations.