A hernia may occur whenever the muscles of the abdomen develop a weak spot or tear. These muscles normal hold the organs and surrounding tissues in place. Principle of treatment remains the same for any hernia:
- identify the border of the hernia defect
- return any protruding organ back into the abdominal cavity
- repair the hernia defect to minimise recurrence
Hernia defect can be repaired in various ways, by using synthetic sutures or by inserting synthetic absorbable or non-absorbable mesh. The mesh provides a scaffold for scar tissue to grow over and integrate into the abdominal wall. This gives the repair great strength and minimise the risk of recurrence.
Other factors will influence recurrence rate (risk of the hernia coming back) such as obesity, diabetes, any medical conditions that impairs immunity and smoking. It is strongly recommended that patient stop smoking prior to any hernia operation.
Repair of hernia can be done either via an open or laparoscopic approach.
Open Surgery
Incision is made over the site of the hernia. Hernia defect is identified, the protruding tissue and organs are pushed back into the abdominal cavity. The defect is closed with sutures. Synthetic mesh may be placed over or under the muscle layer to add support. It is important the defect is repaired without tension (tension-free repair) so sometimes the hernia defect is not closed. Instead, the mesh is placed over the hole and sutured to surrounding tissue.
Laparoscopic Surgery
Laparoscopic repair can be used to treat may types of hernias, most commonly inguinal hernias. The surgery is performed through small incisions in the abdomen. A laparoscope (a thin telescope-like tube) is inserted through a small incision near the umbilicus and a small video camera attached to the scope allows the surgeon to view the abdominal cavity on a video monitor. Carbon dioxide is pumped into the abdominal cavity, or the space between the muscle and abdominal cavity. The aim is to provide a space to improve surgeon’s view and access to the area.
As in open surgery, the hernia defect is identified and ay protruding tissue or organ is returned into the abdominal cavity. Mesh is used to cover the hernia defect and secured into placed by using special staples. When the repair is done, all the instruments are removed and carbon dioxide allowed to escape.
Recovery
Most patients will experience some pain and discomfort around the incision site. Swelling and bruising are common and in men may extend to surrounding area.
Some patient may experience mild nausea but most patients can eat and drink a normal meal fairly quickly after the surgery. Most patients can go home the following day after surgery.
Recovery at home depends on the way repair was performed. Most patients should be able to perform normal daily activities within a few days. The healing process that integrate the mesh into the abdominal wall takes time so it is important to avoid heavy lifting or strenuous exercise for at least 4 weeks after surgery.
Possible Complications
Hernia repair is a very common surgical procedure and is generally very safe. As with all surgical procedures, hernia repair surgery does have risks, despite the highest standards of surgical practice.
General risks such as bleeding and infection are uncommon but can occur in any operation. Antibiotic is given during the operation to reduce the risk of infection. Significant bleeding is rare but may need further surgery or blood transfusion.
The hernia may recur but is uncommon.
Chronic pain may occur due to involvement of a nerve in the repair. This is very uncommon.
Rarely, in men, blood supply to a testicle may be affected and cause atrophy (shrinkage of testicle).
Specific Risks of Laparoscopic Repair
Serious complications related to laparoscopic repair are uncommon.
Injury to organs near the hernia site such as intestine and bladder may occur. Very rarely, abnormal connection may form between the mesh and surrounding tissue such as small intestine (fistula). This may occur many year after the surgery.