Frequently asked questions about laparoscopic repair of Incisional hernia
Hernias result from a hole or defect in the layers of abdominal wall, through which the peritoneum protrudes, forming the sac. The content of intestine can pulled inside the sac and sometime gives rise to serious problems, like, strangulation, obstruction.
An incisional hernia result from a hole or defect in the layers of abdominal wall at the site of a previous surgical incision. The incidence of incisional hernia is less common after laparoscopic surgery but it is a fairly common complication after laparotomy.
During conventional open surgery an opening is made in abdominal layers which are closed by stitches. With time scar tissue forms creating a bond between the two sides of the previous incision. It is never as strong as normal tissue and can tear and. When the scar tissue gives way an incisional hernia, peritoneum protrudes, forming the sac. The content of intestine can pulled inside the sac. Wound infection after surgery is a common cause of incisional hernia because infection interferes with the normal healing process, result is a weaker scar. Obesity, Smoking, malnutrition, deficiency of vitamins chronic cough after operation, weight lifting after operation also contribute to hernias because they also interfere in normal tissue healing.
The hernia can be repaired by either conventional or laparoscopic methods. Incisional Herniorrhaphy is a common operation that general surgeons perform. Laparoscopic Herniorrhaphy is being done at a time when Laparoscopic Cholecystectomy has shown definite benefits over the open technique.
We can imagine a bathtub. When we put the rubber stopper at the outlet and fill it with water, the water pressure pushes the stopper in place and keeps it fixed there. The more the water, the firmer is the stopper. Now, if we were to put the stopper from the outside. Then the water pressure in the tub is going to push the stopper out as the pressure increases. This is Pascal's law.
The same scenario can be imagined with placing a mesh on the hole where the hernia is. Is it going to be better fixed from outside or inside? Open surgery places it from outside and laparoscopic surgery places it from inside.
Almost nil if the operation has been done properly as has been shown in numerous studies abroad.
The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure do increase the risk in certain groups of patients. Most surgeons would not recommend laparoscopic hernia repair in those with pre-existing disease conditions. Patients with Cardiac diseases and COPD should not be considered a good candidate for laparoscopy. The laparoscopic hernia repair may also be more difficult in patients who have had previous lower abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum.
There are several types of mesh used in hernia. Each of these materials is made of special kind of plastics that are compatible with living tissue. Surgeon will select the mesh that is best for the site and size of the incisional hernia.
The hernia is protrusion of the body contents through the weakness in the muscle. It is logical that something coming from inside is best dealt from inside. Also this way one does not cut and weaken the already weak muscle at the hernia site.
The laparoscopic herniorrhaphy generally takes an hour or two to perform, and most patient are able to return home within 48 hours of the surgery.
The mesh used is the same as the one used for open operations over last 30 years. Its safety and efficacy is beyond doubt as proved by the numerous trials all over the world.
The cost of laparoscopic equipment and instrument that is used to fix the mesh inside increases the cost of surgery. Unfortunately these are still imported and will remain expensive till they are locally produced. However, the increased cost should be compared with the gain associated by a quicker and more productive return to work by the majority of the patients. The hidden lowering of cost is due to less leave, early return to normal activity and work, and also from the greatly reduced disruption of the family routine.
Laparoscopic approach has several advantages:
1. Tension free repair.
2. Less tissue dissection and disruption of tissue planes
3. Less pain postoperatively.
4. Low intra-operative and postoperative complications.
5. Early return to work.
Minimal Access Surgeon