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Laparoscopic Inguinal Hernia Repair
What is hernia?
The abdominal wall consists primarily of muscle structures, their fascia, and the peritoneum, which is called the intra-abdominal membrane. Abdominal wall hernias are defined as the protrusion of organs such as the omentum and small intestines, which are located in the abdomen from a weak point in the abdominal wall, out of the abdominal cavity.
If the hernia originates from the groin, it is called an inguinal hernia (inguinal hernia), if it originates from the umbilical hernia (umbilical hernia), it is called an incisional hernia (incisional hernia) if it originates from the surgical site. Apart from these, gastric hernia (hiatal hernia), epigastric hernia and diaphragmatic hernia are other types of hernia we encounter. Of all abdominal hernias, 65% inguinal hernia, 15% umbilical hernia, 9% incisional, 2% femoral and 7% other (Speigelian, epigastric, hiatal, stoma) hernias.
What are the Symptoms of Hernia?
Often there may be no symptoms. Sometimes there may be swelling, discomfort, or pain in the hernia area. This swelling and pain may increase with lifting a heavy load and straining. Swelling may be reduced by the passage of organs placed in the hernia sac into the abdomen from time to time. However, sometimes some of the intestines in the hernia sac cannot enter and get stuck, and hernia suffocation, which causes intestinal circulation disorder, may cause. Paradoxically, while large hernias are painless, small hernias have pain due to compression. Choking increases pain intensity.
How Is Hernia Treated?
Hernia treatment is surgical and this surgical procedure can be performed with open or closed methods. The golden rule in hernia is to be examined by a General Surgery specialist and have surgery as soon as you realize your hernia. Hernia strangulation is a condition that requires urgent surgical intervention.
What is an Inguinal Hernia?
Inguinal hernia (Inguinal hernia) It is the most common type of hernia and its incidence is around 4-5% in the community. Approximately 500,000 inguinal hernia repairs are performed annually in the United States. Gallbladder surgery and inguinal hernia repair are the two most common surgical procedures in General Surgery.
Inguinal Hernia Surgery
Inguinal hernia (inguinal hernia) repair can be performed by open or laparoscopic method. It is necessary to stop eating and drinking the night before the hospitalization. The operation usually takes 30-45 minutes with the open method and 60 minutes on average with the laparoscopic method. The patient can go home the same day.
Open Surgery
Open inguinal hernia repair is usually performed under spinal anesthesia. After anesthesia with the help of a needle advanced through the spine, the patient is anesthetized and operated without any pain. The surgical incision is approximately 8 cm long and the weak area is strengthened with a graft called a patch. After the repair, the procedure is terminated by closing the skin sutures.
Laparoscopic Surgery
Transabdominal preperitoneal (TAPP)– 3 trocars are placed in the abdomen. The weak area is reached by peeling the peritoneum (abdominal membrane) in the hernia area. In order to strengthen this area, after the patches used in open surgery are placed on this weak area, it is fixed with the stapling method. Then the opened peritoneum is sutured again and the surgery is terminated.
Completely extraperitoneal (TEP)– This is a newer laparoscopic method, during which the hernia is repaired with a patch without entering the peritoneal cavity.
Which Technique Is Better?
Both the open technique and the laparoscopic technique are effective and safe methods. However, due to the fewer incisions in the laparoscopic technique, less pain is achieved, faster recovery and earlier return to normal life. If the hernia is bilateral, the laparoscopic method should be preferred more. The laparoscopic method is a procedure that requires further experience. Apart from these, hernia repair with robotic surgery is a procedure that we have applied to our patients more frequently in recent years. Thanks to the advantages of robotic instruments, we can perform more effective surgeries, especially in recurrent (recurrent) hernias and giant hernias.
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