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Laparoscopic Hernia Repair

Approximately 600,000 hernia repair operations are performed annually in the United States. Many are performed by the conventional "open" method. Some are performed laparoscopically. If your surgeon has recommended a laparoscopic repair, this brochure can help you understand what a hernia is and about the treatment.

Laparoscopic Hernia Repair is a recent technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes 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 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 your 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. 3 or 4 quarter inch incisions are usually necessary. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.

This technique may allow the patient to enjoy a shorter recovery time and experience less post-operative discomfort.

Who is a candidate?

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 from the surgery?

• 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.
• 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 rate is not yet known. 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 can't 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 should 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 (s)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 the 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 2 weeks after you operation.