Laparoscopic Inguinal Hernia Repair
Laparoscopic Inguinal Hernia Repair
Inguinal hernia is a common condition caused by a weakening of the abdominal wall near the inguinal canal in the pubic region and is more common in men. If left untreated, an inguinal hernia can cause serious complications. The best and definitive treatment for inguinal hernia is laparoscopic inguinal hernia repair and placement of a supportive mesh with Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy.
What is an inguinal hernia?
The abdominal cavity contains the intestines and other organs, which are protected by the abdominal wall, consisting of four layers. Weak areas can develop in the muscle layer, causing the abdominal contents and inner layer to push through the abdominal wall. This results in a bulge called a hernia.
A hernia is the protrusion of a part of the body through an abnormal opening in another part that reaches a place where it would not normally be. Inguinal hernias occur when there is weakness in the muscles of the lower abdomen, specifically in the inguinal canal, which is a narrow passage through the abdominal wall, where some of the abdominal contents are pushed through this opening.
What are the symptoms of an inguinal hernia?
Not all hernias cause symptoms. One of the clear signs of a hernia is the presence of a visible lump or bulge that appears during certain activities or physical positions and retracts at other times. The patient may also feel pressure or mild pain when the hernia protrudes. It may come out during straining, lifting objects, laughing, or coughing.
What is the main cause of a hernia?
A hernia occurs when a pre-existing weakness or opening in a muscle or connective tissue allows another organ or tissue to push through. Sometimes the weakness or opening is present at birth, but usually develops during life.
What are the risk factors that contribute to the development of an inguinal hernia?
Adults may be at higher risk of developing a hernia in the following cases:
• The job involves lifting heavy objects or standing for long hours.
• Chronic coughing or allergies that cause chronic sneezing.
• Chronic constipation and straining to defecate or urinate.
• History of abdominal or pelvic surgery.
• Pregnancy, especially repeated pregnancies.
• Chronic obesity (body mass index above 30).
Infants may be more likely to be born with a congenital hernia in the following cases:
• Premature birth.
• They have undescended testicles, in the case of males.
• They have other reproductive or urinary tract disorders.
What are the possible complications of inguinal hernia?
Over time, the hernia can become larger. In most cases, complications begin when the hernia becomes stuck and cannot move back into place. If the bowel is stuck, the intestine may become blocked, making it unable to pass food or gas. If the trapped tissue can't access the blood supply, it can lead to tissue death or gangrene, which is called a strangulated hernia, and its symptoms include:
• Severe pain.
• A hernia that does not disappear when you lie down.
• Vomiting.
If any of these symptoms occur, you should call and seek help immediately from Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, as urgent surgery may be required.
Are there any alternatives to surgical intervention?
No, there is no alternative to hernia treatment other than surgery. Some patients may use a support belt or simply leave the hernia as it is. But this will not cure or even improve the hernia.
What are the benefits of surgical intervention?
Surgery eliminates the hernia and prevents the serious complications it can cause. It also allows the patient to return to normal activities.
Surgical repair of inguinal hernia:
Hernia repair options have evolved through the application of advanced techniques and materials, making surgery less invasive, enabling faster healing, and reducing the likelihood of hernia recurrence. The smaller the hernia, or the earlier it is repaired, the easier the surgery.
Inguinal hernia repair surgery involves placing a piece of mesh to reinforce the area and hold it in place. The mesh consists of an elastic material that stays in the abdomen and promotes new tissue growth. There are different types of meshes. Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, is experienced in using the latest procedures and choosing the best type of mesh for the patient.
Laparoscopic inguinal hernia repair is better than open surgery:
Many cases of inguinal hernia can be repaired laparoscopically, especially when the hernia is small. Laparoscopic repair involves inserting special instruments through small incisions in the abdomen, allowing the surgeon to see and perform the procedure. Laparoscopic repair uses a mesh to reinforce the hernia, resulting in a lower recurrence rate. This type of surgery is characterized by less post-operative discomfort due to the smaller incisions, minimal to no scarring, and a quicker return to normal activities, with many people returning to work within a few days. Additionally, laparoscopic surgery allows for deeper placement of the mesh, reducing the chances of hernia recurrence. Laparoscopic inguinal hernia repair is recommended for cases involving hernias on both sides, recurrent hernias, and for those who prefer not to have surgical scars.
Before laparoscopic inguinal hernia repair:
• A few days before the surgery, Dr. Ahmed Abd El Salam orders pre-operative tests, including blood tests, ECGs, and chest X-rays to make sure the heart and lungs are healthy.
• Some medications, such as aspirin or ibuprofen, should be discontinued for one week to 10 days before surgery, as they may increase bleeding.
• Stop smoking to reduce the risk of complications and ensure a speedy recovery.
• Regular exercise is beneficial but exercises that involve heavy lifting or those that may make the hernia painful are not recommended.
How is an inguinal hernia repaired laparoscopically?
1. The procedure is performed under general anesthesia and usually takes about 30 minutes (less than an hour for repairing both sides).
2. Dr. Ahmed Abd El Salam makes three or four incisions of 1 to 2 centimeters in the abdomen. One is near the navel, so he can insert an instrument into the abdominal cavity to inflate the gas (carbon dioxide), and the other incisions are at the bottom to insert the surgical instruments and the mesh to cover the weakened area.
3. A laparoscope, a fiber-optic tube with a small camera at the end, is inserted through one of the openings, allowing the surgeon to see the surgical field in a magnified and precise view on a television screen. The image on the screen is used to guide the surgeon's movements.
4. Surgeon Ahmed Abd El Salam performs the procedure using small surgical instruments inserted through the other incisions while viewing them on a television screen. The mesh is placed and secured using sutures and/or staples. During this process, Dr. Ahmed Abd El Salam takes care to avoid injuring the nerves near the hernia (which can cause chronic pain if damaged), the blood vessels that can bleed, or the duct that carries sperm from the testicle, which can reduce fertility if injured.
5. Instruments are removed, and incisions are closed with sutures that dissolve over time.
Recovery after inguinal hernia repair:
• You can go home the same day or the next day.
• You can return to normal activities when you feel comfortable, usually after a week.
• Eat a high-fiber diet and use stool softeners if necessary to avoid constipation, which puts pressure on the repair process.
• Strenuous exercise is not recommended for six weeks.
We advise you to proceed with inguinal hernia repair before it progresses or complications occur as mentioned. With the expertise of Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, laparoscopic inguinal hernia repair has become reliable and safe.
What is an inguinal hernia?
The abdominal cavity contains the intestines and other organs, which are protected by the abdominal wall, consisting of four layers. Weak areas can develop in the muscle layer, causing the abdominal contents and inner layer to push through the abdominal wall. This results in a bulge called a hernia.
A hernia is the protrusion of a part of the body through an abnormal opening in another part that reaches a place where it would not normally be. Inguinal hernias occur when there is weakness in the muscles of the lower abdomen, specifically in the inguinal canal, which is a narrow passage through the abdominal wall, where some of the abdominal contents are pushed through this opening.
What are the symptoms of an inguinal hernia?
Not all hernias cause symptoms. One of the clear signs of a hernia is the presence of a visible lump or bulge that appears during certain activities or physical positions and retracts at other times. The patient may also feel pressure or mild pain when the hernia protrudes. It may come out during straining, lifting objects, laughing, or coughing.
What is the main cause of a hernia?
A hernia occurs when a pre-existing weakness or opening in a muscle or connective tissue allows another organ or tissue to push through. Sometimes the weakness or opening is present at birth, but usually develops during life.
What are the risk factors that contribute to the development of an inguinal hernia?
Adults may be at higher risk of developing a hernia in the following cases:
• The job involves lifting heavy objects or standing for long hours.
• Chronic coughing or allergies that cause chronic sneezing.
• Chronic constipation and straining to defecate or urinate.
• History of abdominal or pelvic surgery.
• Pregnancy, especially repeated pregnancies.
• Chronic obesity (body mass index above 30).
Infants may be more likely to be born with a congenital hernia in the following cases:
• Premature birth.
• They have undescended testicles, in the case of males.
• They have other reproductive or urinary tract disorders.
What are the possible complications of inguinal hernia?
Over time, the hernia can become larger. In most cases, complications begin when the hernia becomes stuck and cannot move back into place. If the bowel is stuck, the intestine may become blocked, making it unable to pass food or gas. If the trapped tissue can't access the blood supply, it can lead to tissue death or gangrene, which is called a strangulated hernia, and its symptoms include:
• Severe pain.
• A hernia that does not disappear when you lie down.
• Vomiting.
If any of these symptoms occur, you should call and seek help immediately from Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, as urgent surgery may be required.
Are there any alternatives to surgical intervention?
No, there is no alternative to hernia treatment other than surgery. Some patients may use a support belt or simply leave the hernia as it is. But this will not cure or even improve the hernia.
What are the benefits of surgical intervention?
Surgery eliminates the hernia and prevents the serious complications it can cause. It also allows the patient to return to normal activities.
Surgical repair of inguinal hernia:
Hernia repair options have evolved through the application of advanced techniques and materials, making surgery less invasive, enabling faster healing, and reducing the likelihood of hernia recurrence. The smaller the hernia, or the earlier it is repaired, the easier the surgery.
Inguinal hernia repair surgery involves placing a piece of mesh to reinforce the area and hold it in place. The mesh consists of an elastic material that stays in the abdomen and promotes new tissue growth. There are different types of meshes. Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, is experienced in using the latest procedures and choosing the best type of mesh for the patient.
Laparoscopic inguinal hernia repair is better than open surgery:
Many cases of inguinal hernia can be repaired laparoscopically, especially when the hernia is small. Laparoscopic repair involves inserting special instruments through small incisions in the abdomen, allowing the surgeon to see and perform the procedure. Laparoscopic repair uses a mesh to reinforce the hernia, resulting in a lower recurrence rate. This type of surgery is characterized by less post-operative discomfort due to the smaller incisions, minimal to no scarring, and a quicker return to normal activities, with many people returning to work within a few days. Additionally, laparoscopic surgery allows for deeper placement of the mesh, reducing the chances of hernia recurrence. Laparoscopic inguinal hernia repair is recommended for cases involving hernias on both sides, recurrent hernias, and for those who prefer not to have surgical scars.
Before laparoscopic inguinal hernia repair:
• A few days before the surgery, Dr. Ahmed Abd El Salam orders pre-operative tests, including blood tests, ECGs, and chest X-rays to make sure the heart and lungs are healthy.
• Some medications, such as aspirin or ibuprofen, should be discontinued for one week to 10 days before surgery, as they may increase bleeding.
• Stop smoking to reduce the risk of complications and ensure a speedy recovery.
• Regular exercise is beneficial but exercises that involve heavy lifting or those that may make the hernia painful are not recommended.
How is an inguinal hernia repaired laparoscopically?
1. The procedure is performed under general anesthesia and usually takes about 30 minutes (less than an hour for repairing both sides).
2. Dr. Ahmed Abd El Salam makes three or four incisions of 1 to 2 centimeters in the abdomen. One is near the navel, so he can insert an instrument into the abdominal cavity to inflate the gas (carbon dioxide), and the other incisions are at the bottom to insert the surgical instruments and the mesh to cover the weakened area.
3. A laparoscope, a fiber-optic tube with a small camera at the end, is inserted through one of the openings, allowing the surgeon to see the surgical field in a magnified and precise view on a television screen. The image on the screen is used to guide the surgeon's movements.
4. Surgeon Ahmed Abd El Salam performs the procedure using small surgical instruments inserted through the other incisions while viewing them on a television screen. The mesh is placed and secured using sutures and/or staples. During this process, Dr. Ahmed Abd El Salam takes care to avoid injuring the nerves near the hernia (which can cause chronic pain if damaged), the blood vessels that can bleed, or the duct that carries sperm from the testicle, which can reduce fertility if injured.
5. Instruments are removed, and incisions are closed with sutures that dissolve over time.
Recovery after inguinal hernia repair:
• You can go home the same day or the next day.
• You can return to normal activities when you feel comfortable, usually after a week.
• Eat a high-fiber diet and use stool softeners if necessary to avoid constipation, which puts pressure on the repair process.
• Strenuous exercise is not recommended for six weeks.
We advise you to proceed with inguinal hernia repair before it progresses or complications occur as mentioned. With the expertise of Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant for Bariatric Surgery, Faculty of Medicine at Kasr El-Ainy, laparoscopic inguinal hernia repair has become reliable and safe.
