Laparoscopic Hernia Surgery in Udhampur

A hernia occurs when an internal organ or any other body part pushes through a weak spot in the muscle or tissue that contains it, leading to an abnormal lump or bulge, typically in the abdomen, umbilicus, or groin area. Hernia most commonly occurs in the abdomen; e.g., when your abdominal wall muscles are weakened, your intestines can push through the abdominal wall, causing a bulge under the skin of your abdomen, near the groin, or your navel.  Hernias can be present at birth or may develop later in life, between the ages of 40 and 70. They are classified according to their location and type.

         According to Their Location

• Inguinal Hernia: This is the most common type of hernia and has a male predominance. It develops when the intestines or abdominal fat breaks through the abdominal wall into the groin (inguinal) region.
• Incisional Hernia: This develops due to protrusion of tissue or fat out of the scar from previous surgery.
• Femoral Hernia: This hernia has a female predominance occurring in the topmost portion of the inner thigh and develops due to the bulging out of intestines through the groin.
• Umbilical Hernia: This usually occurs in babies under 6 months of age and develops due to weakening of the abdomen muscles, which leads to their intestine bulging out of the navel (belly button/umbilicus).
• Hiatal Hernia: This develops when a part of the stomach pushes through the opening in the diaphragm (a muscular structure that separates the chest from the abdomen) into the chest. 

 According to Their Type

• Reducible: When the hernia can be pushed back into the opening from which it originated.
• Irreducible: When the hernia cannot be pushed back into the opening and the abdominal contents/organs are present in the hernia sac.
• Strangulated: When the tissue/organ becomes entrapped inside the hernia blocking the blood supply to that organ (surgical emergency).

The hernia can be managed conservatively when it is small and not causing any symptoms. Once the hernia increases in size and causes complications like severe pain, abdominal bloating, constipation, fever, nausea, vomiting, chest pain, indigestion, heartburn, and acid reflux (due to obstruction or strangulation of the hernia), surgical intervention is needed.

Conservative Management 

A hernia can be managed conservatively when it is small in size and causes no symptoms or only mild symptoms like pain, nausea, and vomiting. The non-surgical treatment includes lifestyle changes such as losing weight, exercising daily, following a nutritious diet, using hernia belts and trusses, reducing stress, and using ice therapy for pain relief.

Surgical Management

Hernias do not go away on their own and may require surgical removal to avoid complications. Rapidly growing hernias can impinge (press) against the surrounding structures where they develop, causing several complications.  Depending on the type, size, and complication (if present) of the hernia, your surgeon will suggest the method that would be ideal for you.

Open mesh surgery and laparoscopic surgery are the two main surgical approaches for hernia repair. Open surgery has become an outdated surgical approach for most types of hernia (except for umbilical and femoral hernias) owing to the larger incision (cut) involved, more prominent scarring, and prolonged recovery time.

Currently, laparoscopic surgery is the best choice for surgically treating most types of hernias. It is minimally invasive (involves less bleeding and trauma) with a high success rate and minimal postoperative complications. Laparoscopic hernia surgery is done under general anesthesia with 3–4 small incisions, and a laparoscope is used to visualize the parts inside the body.  A laparoscope is a  thin, telescope-like instrument with an attached video camera and a light at its end, inserted through a tiny incision at the belly button (umbilicus). 

Preparation is essential before laparoscopic hernia surgery for a smooth recovery. A few days before the surgery:

• Your surgeon will discuss your medical history and the medications that you are currently on. You will be asked to stop some medications, such as blood thinners (medicines taken to prevent blood clots), a few days before the procedure, as these can cause excess bleeding during and after the surgery.
• Your surgeon will conduct a physical examination to evaluate the extent and location of your hernia. 
• Additional imaging tests will be advised to reach a final diagnosis, like an ultrasound scan of your abdomen and pelvis, CT (Computed Tomography) scan, or MRI (Magnetic Resonance Imaging) scan.
• If you are a smoker, you must stop smoking immediately as it might delay your healing process and increase your risk of developing infection post-surgery.
• You will be advised to stop consuming alcohol for at least 3 to 4 weeks before your surgery, as alcohol interferes with the healing.
• You will need to fast (no solids or liquids) for about 8 -12 hours before the surgery, and laxatives may be given for emptying your bowels.
• You would be asked to wear loose-fitting and comfortable clothes on the day of your surgery.
• You will have to arrange for a family member to drive you home as you cannot drive due to the effects of anesthesia.

Laparoscopic surgery is an outpatient procedure with no hospitalization required. However, you may be observed for 1 to 2 days after complex hernia surgery. The time taken for uncomplicated hernias is 30 to 90 minutes and 2 to 5 hours for complex hernias.

• You will be given general anesthesia (a numbing solution that makes you unconscious), and a breathing tube to help you breathe throughout the surgical procedure.
• Your pulse, heart rate, and blood pressure (BP) are continuously monitored during the procedure.
•  The surgical area will be cleansed with an antiseptic solution to remove any debris or contaminants from the surface that pose a risk of infection.
• Your surgeon will make 3 to 4 smaller incisions (cuts) on the skin around the hernia site.
• A laparoscope on a projection monitor will be inserted through one incision to visualize the hernia defect.
• Surgical instruments will be inserted through other small incisions.
• The hernia sac will be removed from the defect, and a prosthetic (artificial) mesh will be placed over it to cover the defect.
• The incisions are closed with sutures (stitches) that usually dissolve on their own.
• A waterproof surgical plaster or dressing will be placed over the sutured wound.
• You will likely be observed for 1 to 2 hours before you are allowed to go home once the anesthesia wears off.
• You may experience mild pain and discomfort for the initial 24 to 48 hours, which can be managed by pain medications.

After the procedure, you will spend 1-2 hours in the recovery room, where your vitals (body temperature, pulse rate, respiratory rate, and blood pressure) will be monitored until they are stable. Before you go home, your doctor will give you the necessary instructions to follow during recovery and prescribe medications such as painkillers and antibiotics (medications to prevent bacterial infections).

The recovery period depends on the type of procedure. Most people return to normal activities 2 to 3 weeks after the surgery. You may experience pain for a few days after the hernia surgery. To speed up post-surgery recovery, follow these dos and don’ts at home:

Do’s

• Rest on the day of your surgery and for the next 24 to 48 hours since your body needs time to heal. Rest and adequate sleep boost your immunity.
• Consume a healthy, fiber-rich, fat-free diet to improve digestion and aid in bowel movements. Consume small, frequent meals 3 to 6 times daily for the first 3 to 4 weeks post-surgery.
• Drink at least 6 to 8 glasses of water daily to hydrate yourself since dehydration can strain your muscles.
• Shower 24 to 48 hours after the surgery. Check this with your doctor; some surgeons recommend keeping the incision dry for a few more days.
• Keep your wound clean and dry to avoid the risk of infections. Change your dressing regularly and reapply the gauze after bathing.
• Try to stay active post-surgery to prevent blood clot formation, reduce gas formation, and aid in good digestion. Regular walks and low-impact exercises like yoga can help improve your metabolism and stimulate your bowel movements.
• Wear loose, comfortable clothes to avoid straining the abdominal and pelvic muscles and rubbing your incision (cut).

Don't's 

• Do not drive or ride for the initial 3 to 4 weeks since the urge for sudden breaks during an emergency while driving or riding can strain your muscles around the operated site. 
• Avoid any strenuous exercise or activity and lift heavy objects since this can interfere with wound healing.
• Avoid swimming and other sports-related activities for at least 3 to 4 weeks.
• Avoid smoking, which may cause dehydration and excess muscle strain and delay wound healing. Nicotine present may prevent the blood flow to the wound.
• Avoid alcohol consumption as it may increase bruising and swelling post-surgery.
• Do not miss your follow-up appointments since it helps evaluate your wound and check any complications that may develop post-surgery.

Benefits 

• A minimally invasive procedure that involves minimal bleeding.
• Shorter time for healing and recovery; hence you can resume work early.
• Cosmetically acceptable as the surgeon make multiple small incisions (3 to 4) rather than one large cut in the abdomen.
• Less damage to the surrounding tissues and structures.
• Compared to open surgery, there are fewer chances of postoperative complications like infections, sepsis, etc.
• Reduced hospital stay and lower expenses.

Risks

• You may have an allergy to the medications used in anesthesia during surgery, which may cause hypersensitive reactions.
• Injuries to your blood vessels, nerves, or organs by the instruments used by the surgeon.
• Infection may develop due to spilling the bowel contents into the abdominal cavity.
• Shoulder or chest pain due to the anesthetic gas used during surgery.
• Blood clot formation in the legs or arms due to immobility can travel to the lungs and cause respiratory arrest.
• Soft tissues or bowel segments can get trapped in the hernial opening, which can cause strangulated hernia (life-threatening)

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