Hernia Repair Inguinal (Laparoscopic)
|Your doctor has told you that you have a hernia. But what does that actually mean?
In general terms, we can say that a hernia occurs when the layers that make up the abdominal wall weaken. In other words, the fabric of muscle and other tissues which protect the gut, develops a defect, or weakness. Through that defect the peritoneum (PER-IT-TA-NEE-UM) - and perhaps other organs - push their way outward, forming a lump which can be felt - and sometimes seen - protruding from the abdomen.
During normal childhood development, boy's testes slowly descend from the interior of the abdomen, down into the scrotum. They pass through the abdominal wall by way of a natural passageway called the inguinal canal.
In men, the inguinal canal contains blood vessels that supply the testes, as well as the vessel that carries sperm to the penis. Hernias that occur due to a weakness in the abdominal wall at the inguinal canal, are called inguinal hernias. And not surprisingly, men are 25 times more likely than women to experience a hernia in this area.
Some inguinal hernias press directly through the floor of the inguinal canal.
Others follow the route taken by the blood vessels that supply the testes. This kind of hernia - called an indirect hernia - can even push all the way into scrotum.
Perhaps you're wondering: what causes a hernia to develop? There's no single cause. Most people understand that hernias can sometimes occur following sudden, forceful lifting. But most often, hernias develop gradually ...
... and finally make their appearance when the abdominal wall is under somewhat less dramatic pressure. Pregnancy, constipation, straining during urination - even repeated coughing - any of these actions can, in fact, put enough pressure on an abdominal weak spot to cause a hernia.
Symptoms of hernias can vary. If you have a mild hernia, you may not even be aware of it. But in most cases, a hernia causes a noticeable lump or swelling. There may be some pain or discomfort - often increasing when standing, and subsiding when lying down.
Hernias become more serious problems if abdominal contents - such as part of the small intestine or another organ - slide into the hernia sack and become trapped there.
If those organs cannot slide easily back into the abdomen,the hernia is said to be irreducible. Irreducible hernias are often painful and can lead to complications.
For example, if the intestine becomes trapped in the hernia sack it is said to be incarcerated.
If the neck of the hernia sack actually pinches off the supply of blood to those organs which have become trapped inside, the hernia is said to be strangulated.
These are both considered to be medical emergencies and if left untreated, an incarcerated or especially a strangulated hernia can lead to very severe illness and even death.
Luckily, the vast majority of hernias are not considered to be emergencies. However, if you should ever feel a sudden onset of severe pain in your hernia, you should definitely seek immediate medical attention.
After allowing a few minutes for the anesthetic to take effect, a small incision is made below the umbilicus; then, a hollow needle will be inserted through the abdominal wall.
And the abdomen will be inflated with carbon dioxide.
An umbilical port is created ...
... for the laparoscope.
Two or more incisions will be made, with care taken to keep the openings as small as possible.
Once in place, the laparoscope will provide video images that allow the surgeon to inspect the hernia and the surrounding tissues.
Once the hernia has been located, the surgeon carefully opens the peritoneum in order to reveal the hernia sac. Next, the surgeon carefully draws the hernia sac back into the abdominal cavity.
A mesh patch is then inserted over the opening in the peritoneum
... and is secured in place with surgical staples.
This patch reinforces the weakened abdominal wall and helps prevent a second hernia from developing in the same space.
Finally, the peritoneum is closed over the mesh - taking care to protect the spermatic cord.
All of the instruments are withdrawn...
the carbon dioxide is allowed to escape...
and the skin is closed with sutures or staples.
Finally, a sterile dressing is applied.
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