Benefits of Minimally Invasive (Laparoscopic) Repair

Minimally Invasive (Laparoscopic) Hernia RepairIn laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient's belly button. Two other small cuts are made (each no larger than the diameter of pencil eraser) in the lower abdomen. The hernia defect is reinforced with a 'mesh' (synthetic material made from the same material that stitches are made from) and secured in position with stitches/staples/titanium tacks or tissue glue, depending on the preference of your individual surgeon.Open Ventral Hernia Repair (Laparoscopic)Incisional, Ventral, Epigastric, or Umbilical hernias are defects of the anterior abdominal wall. They may be congenital (umbilical hernia) or acquired (incisional). Incisional hernias form after surgery through the incision site or previous drain sites, or laparoscopic trocar insertion sites. Incisional hernias are reported to occur in approximately 4-10% of patients after open surgical procedures. Certain risk factors predispose patients to develop incisional hernias, such as obesity, diabetes, respiratory insufficiency ( lung disease), steroids, wound contamination, postoperative wound infection, smoking, inherited disorders such as Marfan's syndrome and Ehlers-Danlos syndrome, as well as poor surgical technique. Approximately 90,000-100,000 incisional hernia repairs are performed annually in the United States. These hernias present much the same way inguinal hernias do. That is, they present with a bulge near or at a previous incision. Some patients may experience discomfort, abdominal cramping or complete intestinal obstruction, or incarceration as a result of these hernias.The principle of surgical repair often entails the use of prosthetic mesh to repair large defects in order to minimize tension on the repair. A tension free repair has a lesser chance of hernia recurrence. Smaller defects such as umbilical hernias can often be closed without tension by simple suture repair without mesh. Traditionally, the old scar is incised and removed, and the entire length of the incision inspected. Generally, there are multiple hernia defects other than the one(s) discovered by physical examination. The area requiring coverage is usually large and requires much surgical dissection. A prosthetic mesh is used to cover the defect(s), and the wound closed. This is a major surgical procedure and often complicated. Infection rates following repair may be as high a 7.0%. Recurrence can be up to 5%, or higher, depending on the patient's preoperative risk factors. While the use of prosthetic mesh has decreased the number of recurrences, it has also been implicated in increased infection rates, adhesion or scar formation of the abdominal contents to the anterior abdominal wall leading to intestinal obstruction and fistula formation. However, overall, recovery is usually excellent and patients return to normal activity within a matter of weeks.Patients may be admitted the same day of their surgery. Following the procedure and recovery from anesthesia, they are taken to a hospital room where they spend the night. Small ventral hernias and umbilical hernias can be discharged the same day as surgery. We encourage our patients to move as quickly as possible. It is extremely important to be active early in order to stave off some of the complication seen postoperatively, such as pneumonia, deep venous thrombosis and pulmonary embolism (clots in the legs that break off and go the lungs). Postoperative pain is variable, and can be considerable during the first 24 hours. Patients that need to say in the hospital are given I.V. narcotics as needed, and are changed to oral analgesics the next day. Generally, most patients with incisional hernias stay in the hospital 1 or 3 days following surgery. Patients are then seen, by the surgeon, one to two weeks after discharge. There is no dietary restriction. Activity level is restricted by the patient's comfort level. However, it is generally not advisable to engage in any strenuous exercise or heavy lifting for several weeks, to allow the hernia repair to heal.Risks of Minimally Invasive (Laparoscopic) Hernia Surgery

Is Everyone a Candidate for Laparoscopic Hernia Repair?

What Happens if the Operation Cannot be Performed by the Laparoscopic Method?

What Preparation is required for Surgery? Most hernia operations are performed on an outpatient basis, meaning the patient will go home the same day that the operation is performed.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 of 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 thinner or arthritic medication you should discuss with your surgeon the proper timing of discontinuing some medications before your operation.What Should I Expect After 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 pain, this will be mostly during the first 24 to 72 hours. Pain prescriptions will be given to take home.Most patients are off work for 1 week. You may go back sooner if you feel up to it. The only restriction is no heavy lift (>20 lbs.) for 2 weeks.A friend or family member will need to take you home the day of surgery.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 incision, you should call your surgeon immediately.If you have prolonged soreness and are getting no relief form the prescribed pain medication, you should notify your surgeon. You should call and schedule a follow-up appointment within 2 weeks after your operation.