A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing severe pain and other potentially serious health problems.
Men and women of all ages can have hernias. Hernias usually occur either because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall such as strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. Eighty percent of all hernias are located near the groin. Hernias might also be found below the groin (femoral), through the navel (umbilical), and along a previous incision (incisional).
What are the symptoms of hernias?
A noticeable protrusion in the groin area or in the abdomen
Feeling pain while lifting
A dull aching sensation
A vague feeling of fullness
Nausea and constipation
What is a Hernia and What Causes a Hernia?
You may be asked to consider undergoing a surgical procedure for a hernia. A hernia is a weakness or tear in the abdominal wall. A hernia is sometimes called a rupture. Picture an old bicycle tire. Think of the outer tire as similar to the tissue surrounding your abdominal wall (fat, muscle, and other tissue). Think of the inner tube as similar to the peritoneum (lining of your abdomen), but instead of holding air, the peritoneum holds your intestines and other important organs.
Weakened Abdominal Walls
Usually the abdominal wall is strong enough to hold these organs in place, however, sometimes a hernia may form, causing a bulge of the abdominal lining and sometimes tears. A loop of intestine or fatty tissue may push against the abdominal lining creating a sac. You may feel burning or tingling. There is no immediate danger at this point.
Intestines Pushing into a Sac
Generally a hernia forms a bulge as the intestine pushes into a sac. If the bulge flattens when you push against it or lie down, it is called a reducible hernia. There is no immediate danger and hernia repair is necessary.
Trapped Intestines
A hernia where the bulge cannot be flattened is called a nonreducible hernia. If the intestine is trapped it is called incarcerated. Often there is pain and prompt surgery is needed.
Strangulated Intestines
Intestines that become tightly trapped or strangulated lose blood supply and die. Stangulated intestines can block digestion. The pain can be severe. Immediate surgery is needed to correct the block and repair the hernia.
There are two causes of hernias : -
Congenital and Acquired Congenital hernias are weaknesses of the abdominal wall that are present at birth. Acquired hernias are weaknesses or tears of the abdominal wall caused from wear and tear over several years. Both men and women of all ages have hernias.
Where do Hernia's Occur?
An incisional hernia may occur anywhere on the abdomen where there is a previous surgical incision.
An umbilical hernia may occur around the "belly button" or naval area in the umbilical ring.
A direct inguinal hernia may occur in the groin near the area called the internal ring.
An indirect inguinal hernia may occur in the groin located at the internal ring.
A femoral hernia may occur just below the groin.
Bilateral hernias may occur on both the right and left sides of people.
A recurrent hernia may occur at a site where a previous hernia repair was done.
How is a laparoscopic hernia repair performed?
Laparoscopic surgery uses a thin, telescope-like instrument known as an endoscope that is inserted through a small incision at the umbilicus (belly button). Usually, this procedure is performed under general anesthesia. This requires an evaluation of your general state of health, including a history and physical exam, possibly including lab work and EKG.
You will not feel pain during this surgery. The endoscope is connected to a tiny video camera, smaller than a dime, which projects an "inside view" of the patient's body onto television screens in the operating room. The abdomen is inflated with a harmless gas (carbon dioxide) to allow your doctor to view your internal structures. The peritoneum (the inner lining of your abdomen) is cut to expose the weakness in the abdominal wall. A mesh patch is attached to secure the weak area under the peritoneum. The peritoneum is then stapled or sutured closed. Following the procedure, the small abdominal incisions are closed with a stitch or two, or with surgical tape. Within a few months, the incision are barely visible.
Hernia sac inverted into pelvis
Opening through which hernia is protruding
Testicular cord and vas deferens cleared of tissue
Mesh patch in place over weakness
What are the benefits of laparoscopic hernia surgery?
Three tiny scars rather than one large abdominal incision
Short hospital stay (You might leave the day of surgery or the first day after surgery)
Reduced post-operative pain
Low hospital costs
Faster return to work
Shorter recovery time and earlier resumption of daily activities (a recovery time of days instead of weeks)
What are Expected Results After Having Laparoscopic Hernia Repair Surgery Versus Having an Open Abdominal Surgery?
Decreased postoperative pain
Shortened hospital stay
More rapid return to bowel function
More rapid return to work
Minimally sized incisions with a better cosmetic result
What are the Risks of Having Laparoscopic Hernia Repair Surgery?
As with any surgery there are risks. The risk of one of these complications is no greater than if the surgery were done with the open technique. Complications that can occur are : -
Bleeding
Infection involving the wound, blood or abdomen
Injury to surrounding organs such as the bladder, intestines, blood vessels, nerves or the spermatic tube that goes to the testicles (males)
Difficulty urinating following surgery may occur and a temporary catheter may be ordered to drain the bladder
Numbness and pain in the groin region may require an open surgery technique
Even though a hernia may be repaired, it may return
You should ask your surgeon any questions you have in regards to the risk and benefits of the procedure.
What can I expect after surgery?
It is important to follow your doctor's instructions after surgery. Many people feel better in just a few days. However, you might need to take it easy for a week or two.
How safe is laparoscopic hernia repair?
This procedure is as safe as open surgery, in carefully selected cases, when performed by specialists in this field.
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