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Hernia Surgery

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.

An inguinal hernia is the most common type of hernia. The hernia can appear as a swelling or lump in your groin, or as an enlarged scrotum. The swelling may be painful.
The lump will often appear when straining and disappear when you lie down.

(Unilateral)

Hospital Stay: Hospital Stay: 2 days
Duration: Duration: 1 hr
Cost Estimate: Cost Estimate: 3800 USD - 4800 USD

(Bilateral)

Hospital Stay: Hospital Stay: 2 days
Duration: Duration: 1 hr
Cost Estimate: Cost Estimate: 5000 USD - 6500 USD These are indicative prices in Indian Hospitals

Inguinal hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall. The operation will only usually be recommended if you have a hernia that causes severe or persistent symptoms, or if any serious complications develop.

Complications that can develop as a result of an inguinal hernia include:

  • Obstruction – where a section of the bowel becomes stuck in the inguinal canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
  • Strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply so it does not die

Surgery will get rid of the hernia and prevent any serious complications, although there is a chance of it returning after the operation.

Causes an inguinal hernia:

An inguinal hernia usually occurs when fatty tissue or a part of bowel, such as the intestine, pokes through into the groin at the top of your inner thigh. It pushes through a weak spot in the surrounding muscle wall into the inguinal canal. The inguinal canal is a channel through which blood vessels to the testicles pass in men and through which the round ligament, the ligament surrounding the womb passes in women.

Inguinal hernias occur mainly in men. Most are thought to be due to ageing. This is because as you get older, the muscles surrounding your abdomen tend to become weaker. Inguinal hernias can sometimes appear suddenly due to strain on the abdomen, such as straining on the toilet if you have constipation or carrying and pushing heavy loads. They have also been linked to having a persistent, heavy cough.

There are two ways that an inguinal hernia repair can be performed:

  • Open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen
  • Keyhole/laparoscopic surgery – a less invasive but more difficult technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

There are advantages and disadvantages to both methods. The type of surgery you have will depend on which method suits you and your surgeon’s experience. You should be able to go home the same day or the day after surgery. It’s important to follow the hospital’s instructions on how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound and not straining yourself too soon. Most people make a full recovery from inguinal hernia repair within six weeks, although many people are able to return to driving, work and light activities within two weeks.

The hospital will send you instructions about when you need to stop eating and drinking before the operation. The operation usually takes about 30-45 minutes to complete and you’ll usually be able to go home on the same day. Some people stay in hospital overnight if they have other medical problems or if they live alone.

Open surgery

  • Open inguinal hernia repair is often carried out under local anaesthetic or a regional anaesthetic injected into the spine, which means you’ll be awake during the procedure but the area being operated on will be numbed so you won’t experience any pain.
  • In some cases, a general anaesthetic is used.
  • Once the anaesthetic has taken effect, the surgeon makes a single cut/incision over the hernia. This incision is usually about 6-10cm long. The surgeon then places the lump of fatty tissue or loop of bowel back into your abdomen (tummy).
  • A mesh is placed in the abdominal wall, at the weak spot where the hernia came through, to strengthen it.
  • When the repair is complete, your skin will be sealed with stitches. These are usually a type that dissolve on their own over the days following the operation.
  • If the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the two ends of healthy bowel rejoined. This is a bigger operation and you may need to stay in hospital for 4-5 days.

Keyhole (laparoscopic) surgery

General anaesthetic is used for keyhole inguinal hernia repair, so you’ll be asleep during the operation. During keyhole surgery, the surgeon usually makes three small incisions in your abdomen. A thin tube containing a light source and a camera is inserted through one of these incisions so the surgeon can see inside your abdomen. Special surgical instruments are inserted through the other incisions so the surgeon can pull the hernia back into place.

There are two types of keyhole surgery:

  • Transabdominal preperitoneal (TAPP) – instruments are inserted through the muscle wall of your abdomen and through the lining covering your organs (the peritoneum). A flap of the peritoneum is peeled back over the hernia and a piece of mesh is stapled or glued to the weakened area in your abdomen wall to strengthen it.
  • Totally extraperitoneal (TEP) – this is the newest keyhole technique. It involves repairing the hernia without entering the peritoneal cavity.
    Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue. With keyhole surgery, there’s usually less pain after the operation because the cuts are smaller. There’s also less muscle damage and the small cuts can be closed with glue.

Keyhole surgery tends to have a quicker recovery time in people who:

  • have been treated before and the hernia has come back (recurrent hernia)
  • have hernias on both sides at the same time (bilateral hernias)

However, the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher with keyhole surgery than with open surgery. The risk of your hernia returning is similar after both operations. Discuss the advantages and disadvantages of keyhole and open surgery with your surgeon before deciding on the most appropriate treatment.

After the Procedure

Most patients are able to get out of bed an hour or so after this surgery. Most can go home the same day, but some may need to stay in the hospital overnight.

Some men may have problems passing urine after hernia surgery. If you have problems urinating, you may need a catheter (a flexible tube that will drain urine) in your bladder for a short time.

Most people make a full recovery from inguinal hernia repair within six weeks, although many people are able to return to driving, work and light activities within two weeks.

Bowel movements

Avoid straining. Increase your bowel movements by increasing fiber in your diet or over the counter medications. Be sure to drink 8-10 glasses of water each day.

A hernia is a gap or space in the strong tissue that holds muscles in place. A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear.

In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon like sac. This can allow a loop of intestine or abdominal tissue to push into the sac.

The hernia can cause discomfort, severe pain, or other potentially serious problems that could require emergency surgery.

  • Both men and women can get a hernia.
  • You may be born with a hernia (congenital) or develop one over time.
  • A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimen that can make a hernia go away.

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional). It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain or discomfort when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting. Other times a hernia may be detected by your doctor on a routine physical examination. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. Another sign of this is if the bulge used to come and go, but now is stuck out. These symptoms are cause for concern and you should immediately contact your physician or surgeon.

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall muscle using small incisions, telescopes and a mesh. Laparoscopic repair offers a shorter return to work and normal activity for most patients.

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery, prostate surgery, or underlying medical conditions.

  • Most hernia operations are performed on an outpatient basis, and therefore you will probably go home on the same day that the operation is performed.
  • Preoperative preparation includes blood work, medical evaluation, and an ECG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • It is recommended that you shower the night before or morning of the operation with an antibiotic soap.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E may need to be stopped temporarily for several days to a week prior to surgery.
  • Quit smoking and arrange for any help you may need at home. Smoking may increase the risk of the hernia recurring, or coming back after surgery. In some cases, your surgeon may require that you quit smoking prior to surgery.

There are few options available for a patient who has a hernia.
Most hernias require a surgical procedure. Surgical procedures are done in one of two fashions:

  • The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique can be done with a local anaesthetic and sedation, using a spinal anaesthetic or a general anaesthetic.
  • The laparoscopic hernia repair is done with the use of a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other cannulas are inserted which allow your surgeon to work “inside.” Three separate quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect, and it may be fixed in place using staples, adhesive sealant, or sutures. This operation is usually performed with general anesthesia.

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather good surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.

Once you are awake and able to walk, drink liquids, and urinate, you will be sent home. Some soreness can be expected mostly during the first 24 to 48 hours. You are encouraged to be up and about the day after surgery.

With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a week. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.

Any operation may be associated with complications.

  • Bleeding and infection
  • Injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
  • Difficulty urinating after surgery can occur and may require placement of a catheter, or tube to drain the bladder after surgery.
  • Bruising and swelling of the scrotum, the base of the penis, and the testicles. This will gradually resolve on its own in the vast majority of patients.
  • Recurrence. This long-term recurrence rate is low in patients who undergo laparoscopic repair by an experienced surgeon. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.

It is important to remember that before undergoing any type of surgery-whether laparoscopic or open-you should ask your surgeon about his/her training and experience with the operation.

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101°F (38.3°C)
  • Bleeding
  • Increasing abdominal or groin swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Inability to urinate
  • No bowel movements even after 2-3 days of surgery
  • Chills
  • Persistent cough or shortness of breath
  • Foul smelling drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids

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