About Laparoscopic Hernia Surgery
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About Hernia

A hernia is a weakness or defect in the connective tissues of the abdominal wall that allows a protrusion of fatty tissue or internal organs through the defect appearing as a bulge beneath the skin. There are several types of hernia that you can experience. Most common hernia are inguinal hernias, femoral hernias, umbilical hernias, incisional hernia and hiatal hernias. If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.

Causes

What causes a hernia?

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation. Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth. The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

Symptoms

What are the symptoms of a hernia?

Symptoms depend on the type of hernia. In some cases, you may not have any symptoms.
A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:

• Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).

• Sometimes pain at the site of the bulge.

• Discomfort in the abdomen or groin when lifting or bending over.

• Increase in the bulge size as the time passes.

• A dull aching or dragging sensation at the hernia site.

• A heavy feeling in the abdomen or signs of bowel obstruction.

In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.

Feel free to consult Dr. Brijendra Singh at Brij Laser and Laparoscopy Centre if you notice any of these symptoms.

Signs and Symptoms of hernia in Children

Hernias are common in kids, especially babies right from the time of their birth. They can happen when part of their abdominal wall is weak at birth. If your child has one, you’ll usually notice a bulge in their groin area or around their bellybutton. Hernias often bulge when your child cries, coughs, or strain to pass stools. Sometimes you may also notice that their belly is tender to the touch.

Diagnosis

How is a hernia diagnosed?

A hernia can be usually detected with a physical examination. We may also recommend a few tests to be done in order to further assess the patient’s condition and the root cause of the hernia. Mentioning them below

Ultrasound: This test uses sound waves to scan the patient’s body.

A barium X-ray: It takes images of the patients digestive organ and intestines.

A computed tomography: Also known as CT scan uses X-rays to get pictures of the particular organ.

An endoscopy: It studies the patient’s oesophagus and stomach with the help of a small camera at the end of a flexible tube.

What are common types hernias?

Types of hernias include:

• Inguinal hernia.

• Femoral hernia.

• Umbilical hernia.

• Incisional hernia.

• Epigastric hernia.

• Spigelian hernia

• Diaphragmatic hernia

• Hiatal hernia.

What Is Inguinal Hernia?

Inguinal hernia: This is the most common type of hernia. Both females and males may suffer from Inguinal hernia though men are affected more often than women. In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the lower abdominal wall into the inguinal, or groin, area.

There are 2 types of inguinal hernias:

• Indirect inguinal hernias: This type of hernia is caused by a birth defect in the abdominal wall that is congenital (present at birth) though this may also be commonly found in adults or old age persons.

• Direct inguinal hernias: This type of hernia usually occurs in adult males. These are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or lifting heavy weights.

Inguinal hernias can be on one or both sides of the lower abdomen (groins).

What Is femoral Hernia?

Femoral hernia: Femoral hernias are another type of groin hernias, but occur lower in the body than the more common inguinal hernia. Femoral hernias develop in the upper part of the thigh near the groin just below the inguinal ligament, where abdominal contents pass through a naturally occurring weakness called the femoral canal. Femoral hernias are much less common than inguinal hernias and mainly affect older women. Because of the high incidence of complications, femoral hernias often need emergency surgery.

What Is umbilical Hernia?

Umbilical hernia: An umbilical hernia occurs when an organ, intestine or fatty tissue squeezes through a hole or a weak spot in the surrounding muscle or connective tissue near the navel (belly button). Quite commonly seen in females, especially post pregnancy. Umbilical hernia is the most common cause of disfigurement of navel region.

What Is Incisional Hernia?

Incisional hernia: Hernia that appear post abdominal surgery is known as Incisional hernia. The location depends upon the type of incision chosen for primary surgery. Post C-section hernias are not uncommon.

What Is Epigastric Hernia?

Epigastric hernia: In this type Fatty tissue or organ protrudes through the abdominal area between the navel and lower part of the sternum (breastbone). Although small they may be very painful in a few individuals.

What Is Spigelian Hernia?

Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.

What Is Ventral Hernia?

Ventral Hernia: These are types of hernias that arise at the front of the abdominal wall. They include incisional, epgastric (located below the sternum or “breast bone”), and spigelian hernias (located off the midline towards the side of the abdomen).

What Is Diaphragmatic Hernia?

Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.

What Is Complex Hernia?

Complex Hernia: This is a term often used to describe a type of hernia that is complicated to treat. This may include recurrent hernias, giant hernias, or hernias with associated fistulas or infections, among others.

What Is Hiatus Hernia?

The hiatus is a small hole in the diaphragm through which the oesophagus passes into the stomach. It normally fits very snugly, but it may weaken and enlarge. When this happens, part of the stomach muscles may protrude into it, producing a condition called hiatus hernia. It is very common, occurring in more than half of people over 60 years old, and is rarely serious. A hiatus hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity or smoking.

Treatment

What is the treatment of a hernia?

The treatment is based on the features of the hernia, its impact on your quality of life, and your general state of health. Treatment options may include observation, use of a supportive device, or surgery. Surgery is the only way to fix a hernia. In some cases emergency surgery is required. The treatment option that is right for you will be based on a discussion between you and your surgeon.

Indications for hernia repair surgery include:

• Symptomatic Hernia: Hernia creating symptoms of discomfort, pain or interfering with activities of daily living.

• Incarcerated Hernia: Hernia trapped outside the abdominal wall and cannot be returned back inside the abdominal cavity.

• Bowel Obstruction: Hernia causing a blockage of the intestines requires surgical repair.

• Strangulated Hernia: Hernia that has compromised the blood supply of the contents. There is a high risk of death of the tissues such as intestines that are contained in the strangulated hernia. This requires emergency surgery.

How is hernia repair carried out?

Since there are different Types Of Hernia so there Are Varied Type Of Surgery.Commonest Hernia is inguinal hernia.There are two approaches for surgery for inguinal hernia and that is:

Approach for hernia repair surgery include:

A. Approach from front-by open technique. Most commonest and time tested approach.

B. Approach from behind – by laparoscopy technique(or keyhole) surgery.

Open Surgery

Open inguinal hernia repair is often carried out under local anaesthetic or a regional anaesthetic injected into the spine.
Once the anaesthetic has taken effect, the surgeon makes a single cut (incision) over the hernia. This incision is usually about 6 to 8cm long.
The surgeon then places the lump of fatty tissue or loop of bowel back into your abdomen (tummy).
A mesh is placed in the abdominal wall, at the weak spot where the hernia came through, to strengthen it.
When the repair is complete, your skin will be sealed with stitches. These usually dissolve on their own over the course of a few days after the operation.
If the hernia has become strangulated and part of the bowel is damaged, the affected segment may need to be removed and the 2 ends of healthy bowel rejoined.
This is a bigger operation and you may need to stay in hospital for 4 to 5 days.

Laparoscopic (Keyhole) Surgery

General anaesthetic is used for keyhole inguinal hernia repair, so you'll be asleep during the operation.
During keyhole surgery, the surgeon usually makes 3 small incisions in your abdomen instead of a single larger incision.
A thin tube containing a light source and a camera (laparoscope) is inserted through one of these incisions so the surgeon can see inside your abdomen.
Special surgical instruments are inserted through the other incisions so the surgeon can pull the hernia back into place.
There are 2 types of keyhole surgery.

Transabdominal preperitoneal (TAPP)

Instruments are inserted through the muscle wall of your abdomen and through the lining covering your organs (the peritoneum).
A flap of the peritoneum is then peeled back over the hernia and a piece of mesh is stapled or glued to the weakened area in your abdomen wall to strengthen it.

Totally extraperitoneal (TEP)

This is the newest keyhole technique and involves repairing the hernia without entering the peritoneal cavity.
Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.
The operation usually takes about 30 to 45 minutes to complete and you'll usually be able to go home on the same day.

Extended view Totally extraperitoneal(eTEP)

The eTEP (extended view totally extraperitoneal) technique, a modification of the conventional TEP technique, is based on the anatomical fact that the inguinal preperitoneal space can be reached from almost anywhere on the abdominal wall. The camera port can be placed higher in the abdomen. Its most evident effect is the creation of a larger surgical field. It also allows for a more flexible distribution of ports.

TAR Surgery for Recurrent and Complex Hernia Surgery

Complex ventral hernia repair is a frequent and challenging topic. Reconstructive techniques are numerous but most of them are unable to achieve the goals of hernioplasty. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias.

Which technique is best for Hernia repair?

Both keyhole and open surgery for hernias are safe and work well.
With keyhole surgery, there's usually less pain after the operation because the cuts are smaller. There's also less muscle damage and the small cuts can be closed with glue.

Keyhole surgery tends to have a quicker recovery time in people who:

• have been treated before and the hernia has come back (recurrent hernia)

• have hernias on both sides at the same time (bilateral hernias)

The risk of your hernia returning is similar after both operations.

Choice of technique for hernia repair:

The decisions regarding the laparoscopic vs. open approach hernia repair surgery and regarding use of mesh Vs no mesh will be individualized based on the characteristics of the hernia and the discussion you have with your surgeon.
At Brij Laser and Laparoscopy Centre, Dr. Brijendra Singh discusses the advantages and disadvantages of keyhole and open surgery with all his patients before deciding on the most appropriate treatment.

How is Umbilical hernia surgery performed?

Umbilical hernia repair is a fairly quick and simple operation. It takes about 20 to 30 minutes and it's usually possible to go home on the same day. However, some people stay in hospital overnight if they have other medical problems.
The operation can be carried out under Local,Regional or General anaesthesia. During umbilical hernia repair, the surgeon makes a small cut of about 2 to 3cm at the base of the belly button and pushes the fatty lump or loop of bowel back into the tummy.
The muscle layers at the weak spot in the abdominal wall where the hernia came through are stitched together to strengthen them. For large or adult umbilical hernias, a special mesh patch may be placed in the abdominal wall to The wound on the surface of the skin is closed with dissolvable stitches or special surgical glue. Sometimes, a pressure dressing is applied, which usually stays on for 4 to 5 days.

What is IPOM / IPOM plus repair?

The IPOM (Intraperitoneal Onlay Mesh) technique is a special repair procedure for umbilical/ Incisional/ Ventral hernias where a special composite/ dual layered mesh is introduced into the abdominal cavity and placed from the inside over the hernia opening.
The Laparoscopic IPOM technique can only be carried out under general anaesthesia.
To conduct this Laparoscopic IPOM technique, a small incision is first made in the scar-free abdominal wall. Via this approach, gas is blown into the abdomen to assure better visibility. Then an instrument with a small camera is introduced. Using this optical facility, the surgeon has a clear view on a monitor of the surgical field and the various procedural steps. Via two further small incisions, two more working instruments are advanced into the abdominal cavity. Now the surgeon can, if necessary, detach any adhesions and then expose the contents of the hernial sac. Once the hernia opening is fully exposed, a decision must be taken as to whether a synthetic mesh can be placed directly over the defect (IPOM) – something that is possible for defects measuring up to less than 6.0cm – or whether the defect must be additionally constricted with a suture (IPOM Plus) so that the synthetic mesh is better supported. The synthetic mesh is secured from the inside by means of special tacks with titanium spirals or absorbable screws.

How is hiatus hernia treated?

This may be performed laparoscopically. In a laparoscopic fundoplication, small (1 cm) incisions are made in the abdomen, through which instruments and a fiberoptic camera are passed. The operation is performed using these small instruments while the surgeon watches the image on a video monitor.
Advantages Of Laparoscopic Hiatus Hernia surgery:

• less pain

• Shorter hospitalization.

Patients may need to spend 3 to 10 days in the hospital after surgery.

Why Choose Laparoscopic Surgery Over Conventional Surgery?

Laparoscopic hernia repair requires minimal invasions to fix tears in the abdominal wall. The technique offers rapid recovery and a faster return to work for most patients. A thin telescope-like instrument is inserted through the cuts to treat the patient. It is a safe, feasible, and effective approach.

• Procedure Duration: 45 Minutes

• Procedure Type: Minimally Invasive Procedure

• Treatment Results: Scar-less & Permanent

• Fastest recovery with No Cut, Stitches & Scars

• Painless Procedure

• No Blood Loss

• Least Recurrence Rate

• Only 1 Day Hospital Stay