Laparoscopic Inguinal Hernia Repair
Laparoscopic Inguinal Hernia Repair (groin hernia)
What is it?
An inguinal hernia is a weakness or defect in the abdominal wall which allows nearby tissues to "pouch" or bulge out into a small sack in the groin. This sac may extend into the scrotum in men, but may also occur in women.
What causes it?
Inguinal hernias result from either an embryologic structure that remains open through development or because of chronic stress on a specific weak point in the groin. Like all abdominal wall hernias, inguinal hernia development may be exacerbated through any condition that results in increased abdominal pressure such as cough, straining from constipation, ascites from liver disease, and obesity.
What are the Symptoms?
Some common symptoms include a bulge in the groin or scrotum, pain when lifting, coughing, straining during a bowel movement or urination and prolonged standing or sitting. It is important to note that hernias cannot improve by themselves and usually require surgery. Surgical repair may or may not prevent a hernia from recurring. Hernia-like symptoms should not be ignored but addressed immediately, as they may develop into more serious problems requiring emergency surgery. Hernia contents may become stuck outside the abdomen, a condition which may develop into a surgical emergency if intestines become entrapped with resultant blockage or even death of tissue. Other intra-abdominal organs such as the bladder and colon may also become involved in the hernia leading to resultant problems.
How is it Diagnosed?
An inguinal hernia is usually diagnosed on physical exam, although diagnostic imaging techniques such as CT scan or MRI may be utilized to diagnose small hernias or to aid in preoperative planning.
Treatment Options
Inguinal hernias may be repaired by either a traditional open technique or by a laparoscopic approach. In the open technique, and incision is made overlying the groin bulge and the tissues are dissected in order to separate the hernia sac away from the normal structures. The defect in the abdominal wall is then identified and repaired either by sutures or by securing a piece of mesh over it in a tension-free manner. The latter technique is associated with a lower incidence of recurrence and is the most commonly performed method. Both techniques are typically performed as outpatient procedures.
A laparoscopic hernia repair is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to repair the weakened area through several tiny incisions, most of which are less than a half-centimeter in size. The instruments are used to accomplish the repair from within the abdomen, or the procedure may be performed from within the abdominal wall itself without actually entering the abdominal cavity. The advantages of this method include less pain, smaller scars, and an ability to visualize both sides of the abdomen through a single approach. That being said, this is the preferred technique when there are hernias present on both sides. It is also preferred when a hernia has recurred following a prior repair, as the surgeon is able to dissect through non-scarred tissues in order to fix the defect.
Laparoscopic hernia repair is a safe and effective treatment for hernia complications. However, in the presence of infection, adhesions, or variations in anatomy, this method
becomes dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications.
Other complications, although rare, include bleeding and infection. It is extremely uncommon to require a blood transfusion for this operation. There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
In an otherwise healthy person, little is required to prepare for surgery. Depending on your age, gender, and health problems, some routine blood tests, an EKG and a chest x-ray may or may not be needed. Your surgeon or family doctor will order these tests as needed. You will be asked to refrain from eating 8 hours before surgery. Be sure to let your doctor know what medications you are taking, as some will need to be stopped before surgery. In general, all blood thinners need to be stopped for several days. These include aspirin, Ibuprofen or Motrin, Coumadin and Plavix.
This operation is generally performed with general anesthesia. An IV line will be placed in your arm for fluids and you will be brought into the operation room. The anesthesiologist and nurses will use monitors to check your heart rate and breathing during the procedure. These may include EKG leads, a blood pressure cuff, an oxygen mask and sleeves on your legs to prevent clots from forming.
Once you are asleep, the operating room team will work together to perform your operation. When your operation is complete, you will be awakened from anesthesia in the operating room but you may not remember this. After a few hours in the recovery room, the nurses will help you out of bed and give you something to drink. It is common to feel groggy and nauseated soon after surgery and medication is available to help with these discomforts. At the Ohio State University Medical Center most elective inguinal hernia repair surgery is performed as an outpatient operation. A family member or friend should be available to take you home the same day of surgery.
You may experience pain at the incision sites and mild scrotal swelling post-operatively. This may be alleviated with ice packs applied directly to the groin during the first 24-48 hours. You will be provided with a prescription for narcotic pain medicine. You should take a stool softener in conjunction with this pain medicine in order to prevent constipation. Heavy lifting of greater than 10 lbs or any strenuous physical activity should be avoided until your follow-up appointment. Driving should be avoided particularly while taking narcotic pain medication. Symptoms that should prompt an immediate call the your surgeon include severe pain, fever of > 101 F, inability to urinate, vomiting, redness or drainage at the incision sites, or severe swelling in the groin.
This information is not intended to replace a visit with your physician. If you have further questions, please call 614-293-3230.