Choose the content to read
- Why laparoscopic herniorrhaphy?
- What are the symptoms of hernias?
- What is the diagnosis before laparoscopic herniorrhaphy?
- What is the laparoscopic herniorrhaphy procedure?
- What are the benefits of laparoscopic herniorrhaphy?
- Laparoscopic herniorrhaphy at MedPark Hospital
Laparoscopic herniorrhaphy
Laparoscopic herniorrhaphy is a minimally invasive surgical procedure to repair a hernia via the abdomen using a thin flexible tube with a light camera to push the protruded intestines or internal organs back to their original positions. Laparoscopic herniorrhaphy treats hernias that occur when the intestines or internal organs in the abdomen move from their original position to another via the abdominal wall due to congenital weak abdominal muscles, increased intra-abdominal pressure, or degenerative and lax fascia with age, causing abdominal pain, bloating, and a palpable lump in the region where the hernia protrudes through the abdominal wall. If left untreated, it can lead to dangerous complications such as incarcerated bowels. Laparoscopic herniorrhaphy permanently cures hernias with a keyhole incision, minimal surgical pain, short hospital stays, and a quick return to normal daily activities.
Why laparoscopic herniorrhaphy?
Standard open hernia repair typically involves making a 3–10 cm incision, depending on the location and type of hernia. This increases the risk of blood loss, tissue damage, scarring, incision pain, complications, and a longer recovery time at the hospital and at home.
Laparoscopic herniorrhaphy uses minimally invasive surgery that employs small incisions to insert a laparoscope with an HD camera attached to a fiber-optic light connected to a real-time outside monitor screen to perform hernia surgery inside the abdomen. This results in a smaller incision, less blood loss, less tissue damage, less pain, a lower risk of complications, shorter scars, a short hospital stay of only 1-2 days, and the patient can resume their normal activities within 1-2 weeks.
What are the symptoms of hernias?
Hernia symptoms vary depending on the type of hernia, as follows:
- Inguinal hernia: Presents with a lump in the groin that protrudes when coughing, sneezing, or lifting heavy objects. It may or may not cause pain.
- Epigastric hernia: A noticeable midline lump in the abdomen above the navel, which may be only one or more lumps.
- Umbilical hernia: A lump in the navel that is 1–5 cm in size. It is more distinct when crying or coughing and typically shrinks when lying supine.
- Hiatal hernia: Heartburn, chest pain, acid reflux, difficulty swallowing, shortness of breath when sitting upright or lying supine.
- Femoral hernia: A bulge in the upper inner thigh, just below the groin crease. Discomfort or pain when lifting heavy objects or straining to pass stools.
- Spigelian hernia: A palpable lump on the left or right lower abdominal muscles, with pressure in the abdomen.
- Incisional hernia: A palpable lump at the surgical wound that is more prominent when standing or sitting; the lump may or may not cause pain.
- Obturator hernia: Acute intestinal obstruction that comes and goes, a palpable lump in the lower abdomen, pain in the inner thigh when stretching the leg back or spreading the leg to the side.
What are the risk factors for hernias?
- Abnormal fetal development while in the mother's womb.
- Age-related abdominal wall muscle deterioration and laxity
- Accidents that weaken or damage the abdominal wall muscles
- Post-abdominal surgery causes abdominal wall tissue to lose elasticity.
- Pregnancy-related abdominal muscle weakness and increased abdominal pressure.
- Increased abdominal pressure due to habitual heavy lifting, straining to pass stools, or frequent urination.
- Chronic coughing, chronic obstructive pulmonary disease, emphysema, chronic constipation, ascites, benign prostatic hyperplasia, obesity, or overweight.
What is the diagnosis before laparoscopic herniorrhaphy?
The doctor will diagnose the hernia by inquiring about the location of the lump, whether there is pain or no symptoms, and whether the lump is more visible when coughing, sneezing, lying down, standing, bending over, or sitting, as well as taking a medical history, accident history, previous surgery history, or a history of hernia in the same family, and performing a physical examination and radiological examination as follows:
- Physical examination: The doctor will examine the lump's location, including the abdomen, navel, pubic region, groin, or inner thigh, and perform tests such as having the patient stand, lie down, sit, and cough to look for the hernia lump that may not be visible from the outside.
- CT scans: Check for abnormalities in internal organs from the esophagus, diaphragm, upper abdomen, lower abdomen, abdomen, pelvis, and groin to identify the type and location of the hernia.
What is the laparoscopic herniorrhaphy procedure?
Laparoscopic herniorrhaphy at MedPark Hospital is performed using the gold standard for the surgery using a minimally invasive incision (MIS) in both the total extraperitoneal (TEP) approach and the transabdominal preperitoneal (TAPP) approach, prioritizing safety and treatment success outcomes as follows:
Preoperative laparoscopic herniorrhaphy
- Stop taking anticoagulants such as aspirin, ibuprofen, or Plavix for at least 7 days.
- Those with a history of allergies to any type of medication must notify the doctor in advance.
- Stop drinking, eating, and smoking at least 6 hours before surgery.
Intraoperative laparoscopic herniorrhaphy
- The anesthesiologist administers general anesthesia to render the patient unconscious. The surgeon makes 3 keyhole incisions in the abdominal wall: one 1 cm incision at the navel for inserting the laparoscope and two 0.5 cm incisions for inserting surgical instruments.
- The surgeon inserts a specialized trocar through the umbilical incision, inserts the laparoscope, and inflates the preperitoneal distention balloon to create space between the abdominal wall muscle and peritoneum. The surgeon removes the trocar and places another trocar port for laparoscope insertion and CO2 insufflation to distend the created preperitoneal space. Then, the surgeon inserts surgical instruments through the lower abdominal ports into this space to identify the hernia sac in the spermatic cord.
- The surgeon frees the fatty tissue around the hernia sac, ligates and divides at the base of the sac, and returns the ligated sac stump to the abdomen.
- The surgeon applies synthetic mesh to cover and secure the fascial defect and the region where the hernia sac is repositioned back into the abdomen with multiple metal tacks.
- The surgeon inspects the surgical site to ensure everything is in order before slowly removing the laparoscope and surgical instruments and closing the surgical incisions with stitches. Typically, laparoscopic herniorrhaphy takes approximately 30 minutes.
Postoperative laparoscopic herniorrhaphy
- The doctor will closely monitor the symptoms and vital signs. If no complications are found, patients can return home. In cases where the treatment is complicated, the doctor may consider admitting the patient to the hospital for 1-2 nights to monitor the symptoms and keep the vital signs normal.
- Patients are advised to turn over on the side, stand, sit, lie down, and walk to stimulate intestinal peristalsis and promote overall mobility.
- When returning home, rest for at least 8-10 hours and take painkillers as prescribed by the doctor continuously to prevent complications.
- Refrain from lifting heavy objects and straining to urinate and defecate for at least 2 months. Refrain from playing sports for at least 4 weeks.
What is the recovery time of laparoscopic herniorrhaphy?
Laparoscopic herniorrhaphy requires approximately 1-2 weeks of home recovery. Patients can resume work, light activities, and full exercise for 4 weeks after surgery.
What are the risks or complications of hernioplasty?
Risks or complications from hernioplasty include bleeding at the surgical site, blood clots, injury to arteries, intestines, stomach, or spermatic cord, difficulty urinating, surgical site pain, scrotal swelling, surgical wound infection, rupture of the synthetic mesh, or hernia recurrence. However, these complications have a low incidence rate, and if symptoms are detected, the doctor will initiate treatment immediately.
What are the benefits of laparoscopic herniorrhaphy?
Laparoscopic herniorrhaphy has various advantages, as follows:
- Minimally invasive, less pain, quick recovery
- The wound heals quickly, and shorter scars
- Less blood loss, less tissue damage.
- Low complications, very low risk of infection.
- The surgery only takes 30 minutes
- Outpatient procedure, no overnight hospital stays (except for those requiring complex treatment).
- The recovery period at home lasts only 1-2 weeks, and daily activities can be resumed quickly.
- Reduce the risk of complications for the elderly, those with underlying diseases, and the vulnerable.
What is the success rate of laparoscopic herniorrhaphy?
According to a survey of those who had laparoscopic herniorrhaphy at a leading hospital or medical center with a team of skilled specialists, the recurrence rate of hernias was only 1%, making it a very effective surgical technique, particularly when compared to open hernia repair, which has a recurrence rate of 5.4%.
Laparoscopic herniorrhaphy at MedPark Hospital
Surgical Clinic, MedPark Hospital in Bangkok, Thailand, led by a team of surgeons specializing in laparoscopic surgery with experience both domestically and internationally, in collaboration with a multidisciplinary team, is ready to diagnose and treat hernias using the MIS (minimally invasive surgery), a laparoscopic surgical technique, offering tiny wound sizes, less pain, and a quick recovery equipped with a JCI standard operating room, state-of-the-art medical technology and equipment, combined with advanced surgical techniques, yielding safe, fast, and precise hernia repair, allowing for the most effective treatment outcome, while providing consistent postoperative care to ensure patients are free of complications, recover quickly, and can resume normal daily activities expeditiously.
