INFORMATION ABOUT INGUINAL HERNIA AND ITS LAPAROSCOPIC REPAIR
Hundreds of inguinal hernias are operated on daily in our country. Some are made by the conventional “open” method. Others are used “laparoscopically “, that is, through three small incisions and with the help of a small camera. If your surgeon has recommended inguinal hernia surgery, this information can help you understand what a hernia is, what treatment options are available, and what to expect before and after surgery.
WHAT IS A HERNIA?
- Inguinal hernias appear due to a weakening of the abdominal wall. When the patient performs some physical effort, a protrusion of the abdominal peritoneum (hernial sac) is produced towards the inguinal canal, which is perceived as a lump. The hernia can cause discomfort, severe pain, nausea, vomiting, and other potentially serious problems that may require urgent surgery.
- Both men and women can develop a hernia, although the incidence is higher in males.
- You can be born with a hernia ( congenital ) or develop one over time ( acquired).
- A hernia does not get better with time, nor does it go away. There are no treatments, exercises or physical therapy that can make it go away.
WHAT CAUSES AN INGUINAL HERNIA?
It is essential to know that anyone can develop a hernia at any age. The groin and umbilical region are the regions of greatest weakness. Hernias can develop due to physical exertion, chronic enlargement of the abdominal wall ( obesity, pregnancy), ageing, previous abdominal surgeries, weakness from birth, etc. Most hernias in children are congenital. In adults, a deficiency of the muscular wall together with some physical overexertion, persistent cough, and constipation.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC INGUINAL HERNIA?
One of the main concerns of patients is postoperative pain and recovery time to resume normal activities. The laparoscopic approach provides advantages over the open process in this regard. The main benefits are:
- Less immediate postoperative pain
- faster recovery
- Return to work in 48-72h
- Return to physical activity in 2 weeks
- Lower incidence of chronic pain
- Lower incidence of wound and mesh infection
- Admission less than 24 hours in most patients
ARE YOU A CANDIDATE FOR LAPAROSCOPIC INGUINAL HERNIA?
- Only in consultation can your surgeon determine if the laparoscopic approach is right for you. According to recent medical publications, the laparoscopic technique is the best option for bilateral inguinal hernias (left and right) and recurrences after open surgery. It is also a perfect option for self-employed professionals and athletes.
- Laparoscopic surgery is performed under general anaesthesia, so the patient must also be a good candidate for this type of anaesthesia.
- In the case of previous pelvic surgeries, the surgeon must assess if he is an excellent candidate to undergo a laparoscopic repair.
WHAT IS THE REQUIRED PREPARATION?
- Most inguinal hernia operations are performed with short-stay admissions or major outpatient surgery ( less than 24 hours ). In many cases, the patient can go home the same day of their operation.
- Preoperative preparation includes medical evaluation, blood tests, chest X-ray, and an EKG, depending on your age and health status.
- After reviewing the risks and benefits of the operation with your surgeon, you will need to give your written consent for the surgery.
- It is advisable to shower the night before or the morning of the operation with antiseptic soap to cleanse the skin.
- After midnight the night before your operation, you should not eat or drink anything except the medication your surgeon has prescribed for you to take with a sip of water the morning of surgery.
- Drugs such as aspirin, anticoagulants, anti-inflammatory drugs (arthritis drugs), etc., may need to be stopped several days before surgery. Your surgeon will provide you with instructions regarding your medications.
- It is highly recommended to stop smoking at least six weeks before any general anaesthesia. Also, smoking can increase the risk of hernia recurrence. Sometimes the surgeon may require you to stop smoking before surgery.
HOW IS THE PROCEDURE PERFORMED?
The only curative treatment for an inguinal hernia is surgery.
- The use of a jockstrap is rarely prescribed as it is often ineffective. It may relieve some discomfort, but it will not prevent the possibility of bowel incarceration or strangulation.
The most common surgical procedures are:
- Open surgery is performed from the outside, making an incision of about 8-10 cm in the skin of the groin or hernia area. An opening is made by planes (skin, subcutaneous fat and fascia of the abdominal muscle) until reaching the hernia. The repair includes the placement of a reinforcing mesh to reduce the risk of the hernia returning. This technique can be done under local anaesthesia and sedation, spinal anaesthesia, or general anaesthesia.
- Laparoscopic hernia repair is performed through three small incisions at the navel level of about 0.5-1 cm. A small camera connected to a monitor is inserted through one of the holes; Through the other two holes, the surgeon can work and repair the hernia by placing a mesh fixed with absorbable clips or sealing adhesive. Typically this operation is performed under general anaesthesia and usually takes about an hour.
WHAT HAPPENS IF THE OPERATION CAN NOT BE COMPLETED BY LAPAROSCOPY?
In a small number of patients, the laparoscopic method cannot be performed. Factors that may increase the chance of choosing or converting to “open” surgery include obesity, previous pelvic surgery with the development of a dense scar ( adhesions ), and the inability to visualise landmark anatomical structures.
The decision to perform the open procedure is at the discretion of your surgeon, either before or during the operation. When the surgeon feels it is safer to change the laparoscopic procedure to an open one, this is not a complication but rather an excellent surgical decision. The decision to switch to an available system is strictly based on patient safety. Anyway, it’s exceptional. Conversion to open surgery.
WHAT CAN I EXPECT AFTER SURGERY?
- After the operation, you will be taken to the recovery room, where you will be monitored for 1-2 hours until you are fully awake.
- Once awake, you will have to urinate, walk and tolerate fluids. If the pain is controlled with prescribed analgesia, you will be sent home.
- Some pain can be expected with any hernia operation, especially during the first 24 to 48 hours. Once home, taking the painkillers for 4-5 days, the pain is usually minimal.
- With laparoscopic hernia repair, you will likely be able to return to your normal activities within a few days. You will be able to make physical efforts after about 15 days.
- You will be able to shower from the first day of surgery, always drying the wounds well and dressing them with Betadine.
- The review will be in the consultation after the first or second week to see the evolution and confirm the healing of the wounds.