Laparoscopic Inguinal Hernia Repair - Procedure and Recovery

Hernia

1. A hernia is a weak spot in the abdominal wall that causes a protrusion.
2. It occurs when the intestines or fat from the lower abdomen push to the inguinal, or groin area.
3. An inguinal hernia does not improve on its own and needs proper treatment.
4. If you have an inguinal hernia, your doctor would most likely recommend surgery.

 

Benefits  of Laparoscopic Inguinal Hernia Repair

1.  less postoperative discomfort and pain
2. reduced recovery time that allows earlier return to full activity
3. easier repair of a recurrent hernia, the ability to treat bilateral hernias concurrently
4. the performance of a simultaneous diagnostic laparoscopy, ligation of the hernia sac at the highest possible site
5. improved cosmesis, and decreased incidence of recurrence

With a mild massage, a small inguinal hernia can be moved back into the abdomen. Large inguinal hernias, on the other hand, do not improve or disappear on their own. Most people with inguinal hernias will need surgery to repair the condition.

Symptoms of an inguinal hernia are:

1. A groin (the connection between the upper thigh and the lower abdomen) bulge
2. Pain in the groin area that is increased while exercising, coughing, or lifting any object
3. A feeling of pressure or weakness in the groin area
4. Swelling in the scrotum (the sac-like structure that holds the male testicles).

What Will Happen if Surgery Is Delayed?

1. Although inguinal hernias seldom result in incarceration or strangulation, if left untreated, significant consequences might arise:
2. Incarcerated hernia: An incarcerated hernia occurs when herniated tissue becomes lodged (stuck) and cannot be easily moved back into place.
3. Strangulated hernia: An incarcerated hernia can become a strangulated hernia if left untreated. The blood supply to the gut could get off,  resulting in its strangulation. This is a potentially fatal medical condition.

There are two methods for inguinal hernia repair: 

a) Open hernia repair and

b) Laparoscopic hernia repair. 

The open hernia approach is suggested when repairing hernias that occur for the first time or are present only on one side of the body. In an elderly person or someone with ina poor health condition, open hernia surgery is suggested.is too weak or frail to have. It is done under general, local or spinal anaesthesia.c, open surgery with a local anaesthetic may be recommended. For recurrent or bilateral hernias (hernias on both sides of the groin),

Whereas, Laparoscopic surgery is usually the best option for patients with recurrent or bilateral hernias.

Laparoscopic inguinal hernia repair involves the following steps:

1. You will be administered general anaesthesia for the surgery.
2. The surgeon will make three small incisions (cuts) in your lower abdomen.[4]
3. The surgeon will inflate the abdomen with air to see the abdominal (belly) organs.[5]
4. A laparoscope (a tiny tube with a light source and a camera) will then be inserted via one of these incisions.
5. The surgeon will then insert surgical equipment into the other incisions to bring the hernia back into place.[4,5]
6. The gut wall will then be reinforced by placing mesh over the defect.[5]

There are two types of laparoscopic inguinal hernia repair:

Transabdominal preperitoneal (TAPP)

1. In this method, the surgeon will insert the instruments through the abdominal muscle wall and the peritoneum lining of the abdominal organs.[4]
2. To strengthen the weak abdomen wall, a flap of the peritoneum will be peeled back over the hernia portion, and a piece of mesh will be stapled or attached to it.[4]

Totally extraperitoneal (TEP)

1. This is a newer technique that involves treating the hernia without accessing the peritoneal cavity (the abdominal space that holds the stomach, intestines, liver).[4]
2. TEP differs from other procedures in that it does not involve penetration in the peritoneal cavity and instead uses mesh to close the hernia from the outside.[6]
3. The surgical incisions are stitched or sealed together with glue once the surgery is over.[4]

What to Ask and Tell Your Doctor?

1. You can ask your doctor the following questions before your surgery:
2. Can my condition be managed without surgery?
3. What is the best treatment option for my situation?
4. What is the procedure for hernia repair?
5. What is the total number of incisions?
6. What is the expected length of my stay in the hospital?
7. How long does it take to recover?
8. Tell your doctor about the following:
9. Your symptoms
10. The severity of pain (if any)
11. Anything that worsens or relieves your symptoms

What to Expect Before Surgery?

You can expect the following:

1. Avoid aspirin and salicylate-containing medicines for at least a week before surgery to reduce your chance of bleeding.[7,8]
2. If you've been taking blood thinners, you'll need to stop taking them temporarily before the surgery because of the danger of bleeding.[7,8]
3. Smoking raises the risk of infection as well as the possibility of a hernia recurrence. As a result, you may be asked to stop smoking at least four to six weeks before the surgery in order to improve the outcome.[7]

What to Expect on the day of Surgery?

1. What to Expect During Surgery?
2. You can expect the following:
3. You will be positioned in a supine (lying on your back with the face facing upwards) position with both arms tucked.[9]
4. Iodine, alcohol, or chlorhexidine-based solutions will be used to clean the surgical site before starting the procedure.[10]
5. Once the chosen solution has dried, the surgeon will cover the surgical field with either iodine-impregnated sticky drapes (sterile surgical cloth) or incise drapes.[10]

 

 

What to Expect After Surgery?

1. The Recovery process in the hospital:
2. Recovery process/expectation after hospital discharge:
3. Return to work/activities
4. Your coordination and reasoning may be hampered for a short time after receiving a general anaesthetic. So, for the first 48 hours after surgery, avoid driving, drinking, and making major decisions.
5. Gradually increase your level of activity. For example, get up and move every hour or so to avoid clot development.
6. For four to six weeks, avoid heavy lifting and strenuous activities.
7. Diet
8. If you strain during bowel motions, it can cause pain around your incision. Constipation can be avoided by drinking enough water and eating a high-fibre diet.
9. Wound care
10. Wearing tight-fitting clothing should be avoided since it can rub against the incision site. In addition, your healing will be hampered as a result of this.
11. Wash your hands prior to and after touching the incision site.

First Follow-up Appointment

1. You must remember the following:
2. You should see your surgeon two weeks following the procedure to be sure your pain is under control and no signs of infection have appeared. 
3. Depending on your progress, your surgeon may recommend a follow-up appointment.[13]