Laparoscopic Repair of inguinal hernia.
There is a performance of approximately six hundred thousand surgeries of hernia repair per year in the United States.
INFORMATION FOR THE PATIENT FROM HIS (HER) SURGEON AND SAGES
There is a performance of approximately six hundred thousand surgeries of hernia repair per year in the United States. Many of them are performed by means of the “open” traditional method. Some hernia repair are performed by means of the use of a small telescope which is known by the name of laparoscope. If your surgeon has recommended a laparoscopic repair this brochure may help you understand what an hernia is and how its treatment is.
WHAT IS A HERNIA?
A hernia occurs when the inner layers of the abdominal muscle are weak, followed to which a lump or a tear is produced. In the similar way, like a camera that is entered through a damage tire, the inner lining of the abdomen pierces the weak area of the abdominal wall and forms a little bag that looks like a baloon. This may let an intestinal loop or abdominal tissue to enter into the aforesaid bag. Hernia may cause severe pain and other problems potentialy serious that may cause a necessary emergency surgery.
- Both men and women can get a hernia.
- It is possible to born with a hernia (congenital) or it can be developed with the passing time.
- A hernia does not get better with the passing time, nor dissapears by itself.
HOW DO I KNOW IF I HAVE A HERNIA?
The common areas where a hernia can appear are: groin (inguinal), the belly button (umbilical) and in the area of a previous surgery (incisional).
Generally is easy to recognize a hernia. Maybe you note a lump beneath the skin. It is possible that you feel pain when lifting up heavy objects, when coughing, when straining to urinate or moving the bowel, or when standing on your feet or sitted during long periods.
Pain can be acute and immediate, or either can be a sordid pain which worses through the end of the day.
Severe pain and continuous, reddening and sensibility are signs that the hernia can be trapped or strangled. Said symptoms are a cause of concern, and indicates that you must contact immediately with your doctor or surgeon.
WHAT CAUSES A HERNIA?
The abdomen wall has natural areas of potential weakness. Hernias can be developed in this areas or other areas due to a big effort over the abdomen wall can develop a hernia in any age. Most of hernias in children are congenital. In adults a natural weakness or an effort while lifting up heavy objects, a persisting cough, a difficulty of moving the bowel to urinate can make the abdomen wall to get weak or to split.
WHICH ARE THE ADVANTAGES OF THE LAPAROSCOPIC HERNIA REPAIR?
The laparoscopic hernia repair is a technique of repairing the tears in the abdominal wall (muscle) by means of small incisions, telescopes and a patch (mesh). In some patients’ cases a quicker return to their jobs and to their normal activities with a reduction of pain may be posible.
ARE YOU A CANDIDATE FOR A LAPARASCOPIC HERNIA REPAIR?
After a deep medical examination your surgeon can determin if the laparoscopic hernia repair suits you. The procedure might not be the appropriate one for some patients that have had a prior abdominal surgery, or have any underlying medical affection.
WHAT PREPARATION IS REQUIRED?
Generally, hernia surgeries are performed in an ambulatory way, therefore it is likely that the patient goes home the same day the surgery is performed.
The surgical preparation includes blood tests, medical evaluation, x-ray of thorax and a electrocardiogram, depending on your age and medical condition.
After your surgeon reviews the risks and potential benefits of the surgery it will be necessary you give a written consent so that the surgery is performed.
It is recommended that you take a shower the prior night or the morning of the surgery.
If you have difficulty to evacuate the abdomen you can use an enema or any similar preparation aftr consulting your surgeon.
After midnight of the night before the surgery you don’t have to eat or drink anything, excepting the medications your surgeon has told you that you are allowed to take with a sip of water the morning of the surgery.
Medicines like aspirine, anticoagulants, anti-inflammatory (medicine for arthritis) and Vitamin E must be suspended in a temporary way during several days, and until a week before the surgery.
Diet medication or St. John’s Wort cannot be taken during the two weeks prior to the surgery.
Stop smoking and make the necessary arragements for any help that you may need at home.
HOW IS THE PROCEDURE PERFORMED?
There are few alternatives at the disposal of a patient that has hernia.
The use of underpants (binder for hernia) is rarely prescribed, since it is generally ineffective.
Most of hernias require a surgical procedure.
Surgical procedures are performed in one or two ways:
1. The open approach is performed from the external through an incision of three or four inches in the groin or hernia area. The incision will extend through the skin, the subcutaneous fat, and will let the surgeon to reach to the defect level. The surgeon might opt of using a small piece of surgical mesh in order to correct the defect or the hole. This technique is generally performed with local anesthesia and sedation, however it can also be performed with spinal or general anesthesia.
2. The laparoscopic hernia repair. In this approach the surgeon inserts, through a cannula, a small hollow tube, a laparoscope (a tiny telescope), connected to a especial camera that allows the surgeon to visualize the hernia and the surrounding tissue in the video screen.
Other cannulas are inserted that let the surgeon to work “from inside”. Generally three or four incisions are missed that measure one quarter inch. The hernia is repaired from behind of the abdominal wall. A little piece of surgical mesh is placed over the hernia defect, and it is pinned up with small surgical staples. This surgery is usually performed with general anesthesia or ocasionally, with local or spinal anesthesia.
WHAT HAPPENS IF THE SURGERY CANNOT BE PERFORMED OR BE COMPLETED BY LAPAROSCOPIC MEANS?
In a small amount of patients the laparoscopic method cannot be performed. Among the factors that can increase the possibility to choose for the “open” procedure or to turned said procedure include obesity, a history of a prior abdominal surgery that caused dense scar tissue, lack to visualized organs or bleeding problems during the surgery.
The decision to perform the open procedure is determined by the criteria of the surgeon, either before or during the surgery itself. When the surgeon feels that is safer to turn the laparoscopic procedure into an open one it is not about a complication, but a sensible surgical decision. The decision of turning it into an open procedure is strictly based on the patient’s safe.
WHAT TO EXPECT AFTER THE SURGERY?
After surgery the patient will be moved to the recovery room where he (she) will be monitored during one or two hours until he (she) is totally awaken.
As son as he (she) is awaken and be able to walk he (she) will be able to go home.
With any hernia surgery you may expect to have some pain, specially during the first twenty four or forty eight hours.
The patient is encouraged to rise and to walk the day after the surgery.
With the laparoscopic hernia repair it is probably that the patient can return to his (her) normal activities in a short time. Activities such as: taking showers, driving his (her) car, climbing stairs, lifting up things, working or having intercourse are included.
Call the doctor’s clinic for a medical control appointment before the next two weeks from your surgery.
WHAT COMPLICATIONS MAY HAPPEN?
Any surgery may present complications. The main complications of any surgery are bleeding and infection, that are slightly frequent in the case of a laparoscopic hernia repair.
There is a slight risk possibility of suffering an injury of the urinary bladder, intestines, blood vessels, nerves or the sperm duct that goes to the testicle.
It is not rare to experience a difficulty to urinate after the surgery, and it is possible that may be necessary to insert a tube in the urinary bledder during a time of one week.
Even when the hernia has been repaired exists the possibility that it may repeat. It is unknown the rate of reappearence of long term. Your surgeon will help you decide if the risks of the laparoscopic hernia repair are minor than the risks of not dealing with the affection.
WHEN SHOULD YOU CALL YOUR DOCTOR
Be sure to call your doctor or surgeon if any of the following symptoms are presented:
- Fever above 101°F (39°C) does not drop.
- Bleeding.
- Abdominal swelling or groin that goes up.
- Pain that is not relieved with medications.
- Nausea or persistent vomits
- Impossibility to urinate
- Shivers.
- Persistent caughing or short of breath
- Purulent drainage (pus) from any incision
- Redness around any of the incisions that gets worst or gets bigger.
- Impossibility to eat or to drink liquids.
This brochure does not pretend to replace the conversation with your surgeon over the necessity of getting an appendicectomy. If you have any question reffered to your necessity of getting an Inguinal laparoscopic hernia repair, its alternatives, the invoicing or the covering of the insurance, or about the training and experience of your surgeon, do not hesitate in asking such surgeon or the personnel of the clinic about it. If you have questions over the surgery or the subsequent control, we ask you to talk about such subjects with your surgeon before or after the surgery.
