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Laparoscopic Hernia Repair

What is Hernia?

Hernia is an abnormal protrusion of an organ through normal or abnormal opening of the walls of cavity containing it. Hernia are if various types,

  • External or internal
  • Simple or complicated
  • Congenital or acquired
  • Unilateral or Bilateral

The commonest Hernias are

  • Inguinal or Groin Hernia
  • Incisional
  • Hiatus Hernia
  • Femoral Hernia

The causes are:

  • Congenital
  • Increased abdominal pressure in chronic cough
  • Constipation prostatism
  • Weakness of abdominal wall due to appendix surgery or old age

Hernia diagnosis are:

  • Pain at the site of hernia
  • Burning sensation at the site
  • Protrusion of internal organs on coughing and its disappearance on lying down
  • Redness and increased swelling when the hernia gets complicated.
  • Vomiting

Complications of Hernia

  • Pain
  • Irreducibility
  • Obstruction
  • Strangulation

Surgery for Hernia

These operations are performed either by open surgery or by laparoscopy. Depending on the fitness of the patient and the onset of complications

Open surgery for Hernia

Often performed under regional or local anesthesia. The scar is larger than in laparoscopy. The recovery takes longer and few patients may land with groin pain syndrome.

Laparoscopy surgery

This surgery is performed under general anesthesia and requires catherisation of the urinary bladder. A small telescope is passed either in front of the peritoneum or behind it and the hernia is treated by reducing the sac and inserting a mesh and fixing it to the abdominal wall.

Advantages of Laparoscopic Hernia Repair

  • Small scar
  • Rapid recovery
  • Less possibility of groin pain syndrome
  • Both sides can be treated through a single scar
  • Cosmetically superior

Complications of treatment

  • Infection
  • Bleeding
  • Recurrence

What is Inguinal Hernia or Groin Hernia?

Inguinal hernias occur in the groin area. It is amongst the commonest of hernia. It is seen in new born and very old patients too.

Diagnosis

  • Reducible swelling in inguinal region
  • Painful or irreducible swelling in the same region

Tests

  • Sonography of the groin
  • Tests for fitness for surgery

Besides routine tests

  • X ray chest
  • ECG
  • 2D echo stress test in suspected iHD patients

Surgery options

  • Open Hernioplasty or Herniotomy
  • Laparoscopic Hernioplasty

Advantages of Laparoscopic Hernioplasty

  • Rapid recovery
  • No postop groin hernia pain syndrome
  • Cosmetically superior
  • Both sides can be tackled thru same incision
  • Intra abdominal surgeries can be carried out

Technique

  • Patient is under general anesthesia
  • Bladder is Catheterized
  • Telescope inserted under vision
  • Additional ports are inserted under telescopic vision
  • Hernial sac is dissected
  • Mesh bed prepared
  • Mesh inserted and tacked
  • Desuflation done
  • Ports closed

Complications

  • Injury to urinary bladder
  • Injury to inferior epigastria vessels

Infection

  • Seroma formation
  • Recurrence

What is Hiatus Hernia?

Herniation of any organ occurs when it pushes or migrates to an area outside of the walls of the cavity confining it.

Hiatus is an opening in the diaphragm, The muscular wall separating the abdomen from the chest cavity. Normally esophagus passes through the hiatus. If the stomach passes into chest then it is called hiatus hernia.

Hiatus hernia is of 3 types

  1. Sliding Hernia
  2. Paraesophageal hernia
  3. Combination of both

 

Sypmtoms of Hiatus Hernia

Sliding hernia is the commonest of hiatus hernia and may present with heartburn. Though all heartburns may not have hiatus hernia

Paraosephageal hernia may give rise to decreased blood supply to stomach and lead to ischaemia of the stomach and its gangrene.


Complications of Hiatus Hernia?

It may remain asymptomatic or give rise to Reflux Esophagitis ie. acid refluxing into esophagus.

Rarely the stomach may suffer from ischemia and gangrene.

Diagnosis of Hiatus Hernia?

Barium swallow and meal can be used to diagnose hiatus hernia.

endoscopy is also used to diagnose the hernia In large Hiatus Hernia CT scan abdomen may be done to know the details of contents of the sac of hernia. PH metry should be performed to demonstrate reflux of stomach contents into esophagus.

PFT is done in patients with large Hernia and in patients with repeated chest infections due to reflux disease.


What is the treatment of Hiatus Hernia?

Hiatus Hernia is treated Laparoscopically. The reflux is prevented by creating an artificial valve by rolling the stomach around lower esophagus

In para esophageal hernia, the sac is dissected off its attachments and reflux is prevented by creating artificial valve in lower end of the esophagus by rolling stomach around it.

Calliberation of new hiatus and esophageal sphincter is mandatory.

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