HERNIA

A hernia is a defect caused by a weakness in the wall of a muscle, tissue or membrane that normally is strong enough to hold an organ(s) in place. Hernias are more common in certain parts of the body such as the abdomen, groin, upper thigh area and bellybutton area. They also can occur in any place where you have had an incision from a previous operation.

Hernias are usually named according to their location. The most common types are listed below.

  • An inguinal hernia appears as a bulge in the groin or scrotum occurring more commonly in men than women.

  • A femoral hernia appears as a bulge in the upper thigh or lower abdomen and may contain fat, a loop of bowel or other part of the abdominal contents. The contents pass through a channel called the femoral canal. This type of hernia tends to occur in older people and is more common in women than in men.

  • A hiatus hernia occurs when part of the stomach that normally resides within the abdomen slides through the diaphragm into the thoracic (chest) cavity. This can cause symptoms of reflux and difficulty swallowing.

  • An incisional hernia can occur at the site of any previous operation, most commonly involving the abdominal wall.

  • An umbilical hernia is a small bulge around the umbilicus (belly button) and may be a congenital or acquired problem.

HERNIA SURGERY

Hernias usually do not get better by themselves and often need to be treated surgically as they have a risk of becoming strangulated. A hernia repair is often performed as an outpatient operation with no overnight stay in the hospital. The operation may be performed as a laparoscopic (keyhole) or open operation.

LAPAROSCOPIC HERNIA REPAIR

Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the layers of the abdominal wall through a small incision. The laparoscope is a small fibreoptic viewing instrument that contains a tiny lens, light source, and video camera.

INDICATIONS & CONTRAINDICATIONS

Laparoscopic hernia repair is superior to open repair in most circumstances due to less post-operative pain, a faster return to normal activities including work, shorter hospital stay and less scarring. It is a particularly useful technique for patients with bilateral (both sides) hernias and recurrent hernias having previously been repaired with open surgery.

Certain conditions make laparoscopic hernia surgery more difficult. They include previous prostatic surgery, previous laparoscopic hernia surgery, patients with massive hernias and patients who cannot undergo a general anaesthetic. These patients tend to do better with open surgery.

Laparoscopic surgery is performed in a hospital operating theatre under general anesthesia. The television camera attached to the laparoscope displays the image of the abdominal wall layers and the hernia on a video monitor. The surgeon makes three small incisions over the abdomen to insert the balloon dissector and trocars (keyholes). A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision. Once the trocars are placed, the keyhole instruments are then inserted to repair the hernia. A sheet of mesh is inserted, positioned and fixed into the abdominal wall to reinforce the repair. After completion of the repair, the gas is evacuated, the trocars are removed and the tiny incisions are closed and dressed with a sterile dressing.

Specific complications of laparoscopic hernia surgery may include local discomfort and stiffness, infection, damage to nerves and blood vessels, bruising, blood clots, wound irritation and urinary retention.

POST-OPERATIVE GUIDELINES

  • Pain medication will be provided and should be taken as directed

  • Dressings should stay in place for 5 days.

  • You may shower after surgery because the dressings are waterproof however avoid bathing until the skin has healed.

  • Swelling in the groin, at the site of hernia may occur due to serous fluid accumulation in the cavity left by reducing the hernia sac.

  • Bruising may appear in the genital area, which is not painful and disappears over 1-2 weeks

  • You are able to drive and resume normal activities when comfortable unless otherwise instructed

  • A follow-up appointment will be made in approximately 2-4 weeks.