Laparoscopic hernia repair GEORGIOS SAMPALIS GENERAL SURGEON. Director of surgical department of Lefkos Stavros of Athens

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1 Laparoscopic hernia repair GEORGIOS SAMPALIS GENERAL SURGEON Director of surgical department of Lefkos Stavros of Athens About 600,000 surgical hernia repair procedures are performed every year... Many of them are performed with the traditional open method and some laparoscopically. If your surgeon recommends laparoscopic repair, this leaflet can help you understand what a hernia and its treatment are. The Laparoscopic Hernia Repair is a recent technique used to correct tears of the abdominal wall (muscle) using small incisions, telescopes and a mesh. This method offers earlier return to work and normal activities and reduction of postoperative pain. What is hernia? A hernia means that the internal layers of the abdominal muscles weaken creating a protrusion. In the same way the inner tube pushes a destroyed wheel outwardly, the weakened abdominal wall is pushed by the internal layer creating a small balloon like a sac. This may allow part of the intestine or abdominal tissue to protrude in the sac. A hernia can cause intense pain or other, possibly, serious problems that may require urgent intervention. Hernias can be found in both men and women. A person can be born with a hernia (congenital) or develop it overtime. A hernia can neither improve overtime or be treated on its own. How would you know that you are suffering from hernia? The usual locations of hernias are in the inguinal region (inguinal hernia), umbilicus (umbilical hernia) and positions of prior surgical procedures (postoperative ventral hernia).

2 It is usually easy to recognize a hernia. A lump may appear under the skin. You may feel pain when lifting heavy objects, when coughing or a dragging sensation when urinating or emptying the bowels or when you are standing or sitting for long. The pain might be acute and direct or dull pain at the end of the day. Intense, continuous pain, erythema and sensitivity are signs that the hernia has been trapped or strangulated. These symptoms are the cause to immediately contact your doctor. WHY ARE HERNIAS CREATED? There are areas in the abdominal region with a more weakened wall. Hernias can be created as a result of intense pressure on the abdominal wall due to injury, age, old incision or some other weak spot which is congenital. A hernia can appear to anyone and at any age. Most of the cases of hernia in children are congenital. In adults, a congenital weak spot or pressure from lifting weight, persistent cough, constipation or dysuria can cause weakening or separation of the abdominal wall. Hernia WHAT ARE THE TREATMENT CHOICES? There are not many choices for the treatment of hernia. The conservative treatment using a hernia support is rarely recommended because it is not usually effective. Most of the hernias require surgical treatment. Two methods are currently used for surgical procedures. Ι. The first one is the traditional method, with an external incision in the inguinal area or wherever the hernia is. The incision extends from the skin to the subcutaneous fat allowing the surgeon to reach the problematic area. The surgeon can choose to use a small surgical mesh to repair the damage or the hole. This method is performed with local anaesthesia but epidural or general anaesthesia can also be used. ΙΙ. The second method is the laparoscopic hernia repair. In this method, a laparoscope (tiny telescope) connected with a special camera is inserted through a tube allowing the surgeon to see the hernia and the surrounding tissue on a screen.

3 Some other tubes are also inserted in the abdominal area allowing the surgeon to proceed internally. The hernia is repaired from the back of the abdominal wall. A small piece of surgical mesh is placed over the defect and is stabilised using small sutures. The procedure is performed with general anaesthesia or sometimes with local or epidural anaesthesia. TEP Method TEP (Total Extraperitoneal) Hernia Repair is the up-to-date most indicated laparoscopic approach for the repair of inguinal hernias. It is a very specialized method in which the surgeon inserts the laparoscope in the hernia region in front of the peritoneum covering the viscera and under the muscular abdominal wall. In this way the procedure is fully performed outside the abdominal cavity, without any contact with the viscera, exactly at the hernia position. This technique allows earlier recovery for the patient and less postoperative discomfort. IS LAPAROSCOPIC HERNIA REPAIR SUITABLE FOR ALL PATIENTS? Only after a detailed examination can your surgeon decide if the laparoscopic hernia repair is suitable for you. This method may not be suitable for some patients who have undergone previous surgical procedure in the abdomen or have significant health problems. The laparoscopic repair is the ideal method for all types of hernia, and in particular for: Recurrence of open inguinal hernia Bilateral inguinal hernias Hernia WHAT ARE THE COMPLICATIONS OF LAPAROSCOPIC HERNIA REPAIR? Each surgical procedure can have complications. The main complications of a surgical procedure are haemorrhage and inflammation, which are uncommon for the laparoscopic method. After the hernia repair, there is the possibility that in the long term the hernia will occur again. The reasons for recurrence are: prolonged weight lifting, chronic cough, risky and extreme sports and others... Your surgeon will help decide if the risks of the laparoscopic hernia repair are smaller than not repairing the damage.

4 What happens if the laparoscopic hernia repair cannot be performed? There is small number of patients that the laparoscopic method cannot be performed due to the inability to get a clear picture or effectively manage the patient s organs. Factors that can increase the possibility to convert a procedure to an open one are: obesity history of previous procedure in the abdominal cavity that has caused deep damage to the tissue or haemorrhagic problems during the The decision to convert to an open procedure shall be taken by the surgeon before or even during the procedure and is solely based on the patient s safety. WHAT KIND OF PREPARATION IS NEEDED? Most of the hernia repair procedures can be performed without the need for the patient to be hospitalized but return home on the same day. On the day prior to the procedure, you should avoid eating or drinking after midnight. Take a bath on the previous night or in the morning of the day of the If you have constipation problems, an enema or some similar preparation is recommended, after consulting your surgeon. Some preoperative exams are required depending on your health condition and the type of anaesthesia used. If you take aspirin, anti-coagulants or medicine for arthritis, you should discuss with your surgeon the time before the procedure you should stop taking them. WHAT SHOULD YOU EXPECT AFTER THE PROCEDURE? After the procedure you will be taken to the recovery room where you will stay until you fully recover from the anaesthesia. When you completely recover and you can walk, you will be allowed to leave. You will experience some muscular pain after the procedure, the same you feel when you exercise the abdominal muscles, usually for 24 to 48 hours. It is recommended that you start walking even from the next day of the With the laparoscopic hernia repair, you will be able to return to your regular activities (bath, driving, climbing stairs, lifting weights, work and sexual activities) before long.

5 The laparoscopic method, as I usually say, has one serious problem: The patient feels so good that can easily be lured to extravagances