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Minimally Invasive Surgery - Hernias

A hernia is defined as an organ or fat which is protruding through an opening in the wall that normally holds it back (show picture). The most common of these is the inguinal (groin) hernia, but here are a few others including umbilical (belly button) and incisional (through the site of an old incision). This problem appears as a bulge in these areas. Hernias can be reducible (go back in either spontaneously or are pushed back) or irreducible (stuck out). Hernias that are irreducible are emergencies and need to be seen by a surgeon promptly. The major concern for this type of hernia is the specific situation where they have intestine inside and can get stuck (show picture). When this happens, the blood flow to that section of intestine can get cut off and it can burst. That can cause serious illness or even death and is a surgical emergency. Fortunately, this is uncommon. Those that are reducible can be repaired to prevent problems from arising. Even so, they can cause significant discomfort, prevent normal daily activities and prevent people from lifting heavy weight for fear of them becoming stuck. In these situations, they can be repaired.

Inguinal hernias can be repaired laparoscopically using 3 small incisions (show picture). Mesh is traditionally placed to prevent recurrence. Mesh is a woven plastic material that is placed behind the hernia to allow the body to scar the area and prevent it from returning. By blocking the hole from behind it is much less likely for it to come back than if it was covered from the top as it is in conventional hernia surgery. Patients who have this surgery usually go home the same day and are instructed to avoid heavy lifting for 1 month until the body has healed. Hernia surgery is generally regarded as being painful; however, using the laparoscopic approach reduces the pain felt by the patient and allows easier return to daily activities.

Umbilical hernias happen to many people. We are all born with a tiny hole in the belly button, through which we were fed when we were growing in the womb. Later in life, this hole may get larger and cause pain much like the groin hernia. This can also be repaired laparoscopically when it has grown to a large size (more than 1.5 inches).

Incisional hernias happen most often after large conventional operations. The body does not heal to as strong as it was before and so hernias can develop in places of incisions. These hernias are more likely to happen after emergency operations, especially if infections were involved. These hernias can be repaired laparoscopically, as many times, there can be more than one. The camera used in laparoscopic surgery can closely look at the abdominal wall from the underside and make sure no other hernias are there. If they are, they can all be repaired by 1 large piece of mesh placed on the underside of the abdominal wall. This operation can be accomplished by the use of a two to three ¼ incision and one ½ inch incision. The mesh is anchored to the abdominal wall with stitches and tacks. Patients undergoing this operation usually go home the same day as well. Pain is less than if repaired by conventional means and there is a much smaller risk of infection and recurrence.

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