A hernia is a hole in the fascia of the abdominal wall and allows the inner lining of the abdominal wall to protrude or bulge. The bulge forms a balloon-like sac (hernia sac). Intra-abdominal contents such as fat or loops of intestine can also protrude through the defect in the fascia and into hernia sac. Loops of intestine or fat can become trapped (incarcerated) or twisted (strangulated) in the hernia sac and block the flow or food in the intestinal tract or compromise its blood supply. Although this is very rare, strangulation may lead to a potentially life threatening and serious problem requiring emergency surgery. Most hernias are identified and treated prior to incarceration or strangulation. Hernias occur in the abdominal wall where the fascia is compromised, most commonly in the groin (inguinal hernias), and areas of previous surgical incisions (ventral hernias). Hernias tend to grow larger over time and can become symptomatic.
There are two different ways to fix hernias, but the principles of hernia repair are the same. The defect in the fascia needs to be repaired in a tension-free manner. Very small defects can be repaired simply by sewing them closed. Larger defects cannot be repaired in this manner, as they would result in large amounts of tension and a higher chance of recurrence. A tension-free repair is accomplished in larger hernias by “patching” the defect with a mesh or patch. The mesh covers the hole in a tension free manner and reinforces the weakened area in the fascia. The two different approaches to hernia repair are an open repair and a laparoscopic repair.
An open hernia repair involves an incision in the area directly over the hernia. The hernia sac is identified and reduced into the abdominal cavity. This reveals the defect in the fascia. A piece of mesh is placed below the fascia in order to span the entire defect and overlap the edges circumferentially. The mesh is sewn into place and the skin is sewn together over the mesh.
A laparoscopic hernia repair involves 3-5 small incisions (all < 1 inch) around the hernia. A laparoscope and long thin instruments are used to perform the operation. The laparoscope functions as a camera to visualize and magnify the abdominal contents to monitors outside of the body. The contents of the hernia are reduced from the hernia sac to reveal the fascial defect. A piece of mesh is placed across the entire defect and overlaps the edges circumferentially. This mesh is secured in place with suture and tacks.
The patient and their surgeon decide the optimal approach to hernia repair on an individual basis.
The advantages of removing the laparoscopic approach include less pain, a faster recovery, a smaller incision, less wound complications, and a lower chance of future hernias.
A liquid diet is started after surgery and patients are advanced to a regular diet as tolerated. Pain medication is given by mouth and the majority of patients return home the day after surgery. Some patients may go home the same day as the operation. Walking is encouraged after surgery, and activity is dependent on how the patient feels. Most patients return to work in one or two weeks depending on the physical requirements of their occupation. Patients return approximately two weeks after surgery for routine follow-up with their surgeon.
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