In the United States, over 5 million people suffer from a variety of hernias and an estimated 700,000 hernia repair operations are performed annually. Many of these repairs are performed by the conventional "open" method whereas some are performed laparoscopically (minimally invasive). Laparoscopic hernia repair is a relatively new procedure that offers patients less postoperative pain, better cosmetic results and a quicker return to work and normal activities.
A hernia is a weakness or defect in the abdominal wall that you were either born with or created due to over exertion (i.e. lifting, straining, coughing etc). As the hernia develops, you may notice an abnormal protrusion of abdominal contents (i.e. fat, intestines) through the weakness or defect. Similar to the inner tube pushing through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall creating a bulge. As the hernia enlarges over time, they can become painful and in some instances may lead to more serious problems requiring emergency surgery.
Common terms that you may encounter when discussing hernias include:
An inguinal hernia occurs in the groin—the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin and may extend into the scrotum. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time. Inguinal hernias can be further classified into:
Ventral hernias, also known as abdominal hernias, can occur anywhere along the abdominal wall. They usually appear in the midline. Ventral hernias typically result from a tear or division in the muscles or fascia as a result of surgery or injury/trauma.
Most often they are usually composed of fat but may occasionally contain intra- abdominal organs (intestines). Ventral hernias can develop as a result of an increase in intra-abdominal pressure from lifting or straining. They can also be congenital in origin or due to a previous surgery.
Ventral hernias can be asymptomatic but if left untreated, it may increase in size and may become strangulated or incarcerated.
The basis of the hernia is separation at the site where the abdominal muscles were re-approximated (re-attached) after an abdominal operation. There may be a single hole, or a so-called Swiss cheese hernia, where there are multiple holes. There are many causes, including impaired wound healing on the part of the patient due to chemical and molecular imbalances, infection at the time of the original operation, poor surgical technique in closing the original incision, genetic factors, cigarette smoking, excessive coughing, and obesity just to name a few.
Incisional hernias can be unsightly, painful, alter a patient’s lifestyle and employment opportunities, and carry a risk of incarceration and/ or strangulation. In some patients there are minimal or no symptoms and the hernia is easily pushed back into the abdomen (reduced). Watchful waiting is an acceptable strategy in this group. Hernia belts are worn by some patients but they probably do little to prevent enlargement or complications, although they do provide support.
The term “sports hernia” is confusing, even to physicians, because by definition the patient doesn't actually have a hernia. It is discussed under the general topic of hernia because they occur in the groin, and when operation is required the procedure is very similar to a standard hernia repair. But the cause of the hernia is not a hole with a neck and a sac, but rather just weakened or stretched tendons or muscles in the groin area, which leads to pain that interferes with function. The diagnosis is essentially one of exclusion when a patient presents with groin pain and no obvious cause by physical examination or x-ray studies. There is considerable interest in sports hernias because they commonly occur in high profile athletes whose occupations are significantly impacted by the condition. However, weekend warriors and athletes making extreme and repeated twisting-and-turning movements are also susceptible to a sports hernia.
Surgical options at AMISurgery include laparoscopic and open methods for hernia repair.
A laparoscopic hernia repair involves 3-5 small incisions. A laparoscope (camera) and long thin instruments are used to perform the operation. The contents of the hernia are returned into their normal position and the hernia defect is clearly identified. A piece of mesh is placed across the entire defect to overlap the edges circumferentially. This mesh is secured in place with suture and tacks.
A liquid diet is started after surgery and patients are advanced to a regular diet as tolerated. Pain medication is given by mouth and the majority of patients return home the day after surgery. Most patients may go home the same day as the operation. Walking is encouraged after surgery, and activity is dependent on how the patient feels. Most patients return to work in one or two weeks depending on the physical requirements of their occupation. Patients return approximately two weeks after surgery for routine follow-up.
Only after a thorough examination can your surgeon determine whether a laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had extensive previous abdominal surgery, hernias found in unusual or difficult to approach locations, or underlying medical conditions.
Risks associated with both procedures:
(This is only a partial list of potential complications)
Average hospital stay:
Type of anesthesia required:
Recovery period: Once you have undergone laparoscopic surgery, your recovery period is relatively short when compared to conventional open surgery. Most patients go home the same day and return to work as early as 2-3 days (average 7-10days). You will be given pain medication along with a laxative to prevent constipation.
If you suspect you have a hernia, consult with your primary care physician promptly. Hernias tend to get bigger over time, and do not resolve without treatment.
Delaying your hernia repair can result in intestinal incarceration (intestine is trapped inside the hernia sac) or strangulation (intestine is trapped and develops gangrene). The latter is a surgical emergency. Under certain circumstances the hernia may be watched and followed closely by a physician. Consult your physician to determine if observation is the proper course of action.
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs 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. 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. The decision to convert to an open procedure is strictly based on patient safety.
Hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. The diaphragm is a muscle that divides the abdomen and the chest. Within the diaphragm there is a small opening (hiatus) that allows your esophagus to pass through and connect to your stomach in the abdomen. In some patients, the opening may be too large allowing the stomach to be pulled into the chest causing a hiatal hernia.
In most cases, a small hiatal hernia does not cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn and chest pain. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.
Most small hiatal hernias cause no signs or symptoms.
Larger hiatal hernias can cause signs and symptoms such as:
Hiatal hernia could be caused by:
Hiatal hernia is most common in people who are:
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain, such as:
Most people with hiatal hernia don't experience any signs or symptoms, and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.
If you experience heartburn and acid reflux, your doctor may recommend medications, such as:
Patients who do not respond well to lifestyle changes or medications or those who continually require medications to control their symptoms, will have to live with their condition or may undergo a surgical procedure. Surgery is very effective in treating hiatal hernias and the symptoms associated with GERD.
At AMISurgery, we offer both laparoscopic and endoscopic repair (incisionless) for hiatal hernias and GERD.
Although laparoscopic anti-reflux surgery has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic anti-reflux surgery in consultation with your primary care physician or Gastroenterologist to find out if the technique is appropriate for you.
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. 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. The decision to convert to an open procedure is strictly based on patient safety.
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GERD symptoms.
Long-term side effects to this procedure are generally uncommon.
Although the operation is considered safe, complications may occur as they may occur with any operation. Complications may include but are not limited to:
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