A hernia occurs when intestinal tissue protrudes through a weak point or tear in the abdominal wall, forming a sac. The protruding tissue may lose blood supply and become obstructed, resulting in serious health problems. Most hernias occur in the groin (inguinal, femoral), navel (umbilical) or at surgical incision sites (incisional).
Surgery is the only method to correct hernias. The most common hernia repair procedure is traditional (open) surgery. Usually done with local anesthesia, a large, deep incision is made through the muscle. The tissue is pushed back behind the muscle, which is then stitched closed, and plastic mesh is placed over the site for support. Full recovery takes four to six weeks.
The minimally invasive technique of laparoscopy, done under general anesthesia, involves the creation of three small incisions in the abdomen, the injection of carbon dioxide gas to create a “work space” and the use of a laparoscope, a thin instrument with a camera on the end allowing the surgeon to see inside the patient’s. Other necessary surgical instruments are employed through the other small incisions. This method causes less trauma to the body, so post-operative pain is reduced and recovery only takes about a week.
In extra-peritoneal balloon laparoscopic hernia surgery, the “work space” is created with an inflatable balloon outside the abdominal cavity. This reduces the risk of bowel and blood vessel perforation associated with regular laparoscopic surgery. General anesthesia is still required and recovery takes about a week.
Laparoscopic Ventral Hernia Repair
A laparoscopic ventral hernia repair is an operation performed to repair a ventral, or abdominal, hernia through a minimally invasive procedure. When performed laparoscopically, this surgery has advantages over traditional surgery, including: less scarring, less pain, less risk of infection, and a shorter recovery period. A ventral or abdominal hernia occurs when there is a weakness in the abdominal wall which develops a tear or hole. The hernia is created as the inner lining of the abdomen pushes through the opening, forming a sac into which a portion of abdominal or intestinal tissue protrudes. A ventral hernia appears as a bulge on the outer wall of the abdomen. Ventral hernias vary in severity and may or may not require surgical repair.
When an organ gets trapped in the hernia, a condition know as incarceration, or becomes strangulated, meaning that blood flow to the organ is cut off, emergency surgery is required. During ventral hernia repair, which is done under general anesthesia, the surgeon pushes the protruding tissue back into the abdominal cavity and attaches surgical mesh to the surrounding muscles to strengthen the area.
The Laparoscopic Ventral Hernia Repair Procedure
Laparoscopic ventral hernia repair is typically performed under general anesthesia. The surgeon begins by creating three or four small incisions in the abdomen. The laparoscope and a tiny camera will be inserted through one of these incisions and miniature instruments to repair the hernia through the others. Typically, during surgery, mesh in the form of a synthetic patch is used to repair the weakness in the abdominal wall. The patch is held in place with surgical tacks, or in some cases, sutures.
Complications a Laparoscopic Ventral Hernia Repair
In a small number of cases, it may be impossible to use surgical mesh, since some patients have a history of rejecting such products. In these cases, sutures alone, called primary closures, are used to repair the hernia. Unfortunately, primary closures result in a higher rate of reherniation.
Although there are many advantages to the laparoscopic approach, it is possible that particular patients may not be good candidates for laparoscopic surgery. Often, this is because the patient has a history of rejecting products like the surgical mesh normally used in such procedures. There may also be a complication that arises during the laparoscopic procedure that requires a switch to open surgery.
Risks of a Laparoscopic Ventral Hernia Repair
Laparoscopic ventral hernia repair is a common and safe type of surgery. Nonetheless, any surgical procedure involves a small degree of risk. These risks may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Postsurgical infection
- Damage to adjacent organs
- Breathing problems
In the case of a ventral hernia repair there is also a relatively high risk of reherniation and the need for further surgery, though this risk can be lessened by abstaining from smoking and following other postoperative instructions. Moreover, the risk involved in not proactively repairing a ventral hernia is typically far greater than the surgery itself, since the hernia may become incarcerated or even strangulated and become life-threatening.
Recovery from a Laparoscopic Ventral Hernia Repair
The recovery from laparoscopic ventral hernia repair is usually an uneventful one. Immediately after surgery, rest is necessary. A diet high in fiber is recommended to avoid constipation. Within a day, the patient will be walking. Within a week, the patient should be able to resume normal activities. More strenuous activities, such as playing sports, heavy lifting or even sexual activity may not be permitted for several weeks. It is important to discuss postsurgical activities with the doctor in order to avoid disrupting the healing process. After surgery, issues which may have led to or exacerbated the development of the hernia, such as obesity or chronic coughing, must be addressed.
An adrenalectomy is a surgical procedure designed to remove one or both adrenal glands (located above the kidney). Adrenalectomies are used to treat cancerous or benign (non-cancerous) tumors that develop in the adrenal gland. The procedure is performed using traditional long incisions or laparoscopically.
Traditional adrenalectomies use a horizontal incision under the rib cage, a vertical incision in the middle of the stomach, an incision along the back under the rib cage, or incisions on both sides of the body. The adrenal glands are then disconnected from associated blood vessels and removed. Laparoscopic adrenalectomies use 3 to 4 small incisions, small instruments, and a small tube with a camera on the end (the laparoscope). The abdomen is expanded by filling it with gas, and the camera is used to visualize the adrenal glands. A small plastic bag is inserted into the abdomen and used to collect the glands. Then, the bag is removed through an incision located in the belly button.
A splenectomy is a surgical procedure designed to remove a diseased or damaged spleen (the organ that helps filter the blood and fight infections). A splenectomy may be necessary if a patient has an injury to the spleen, a blood clot in nearby blood vessels, blood cell disease (e.g., hemolytic anemia), sickle cell anemia, an abscess or cyst in the spleen, a tumor or cancer that affects the spleen, or cirrhosis of the liver.
Prior to a splenectomy procedure, the surgeon will inflate the abdomen with gas for better visualization and access to the affected area. For an “open” splenectomy, the surgeon will then use 1 long incision that runs across the middle of the abdomen or on the left side of the abdomen below the ribs to remove the spleen. For a “laparoscopic splenectomy” the surgeon will make several small incisions. A small tube with a camera on the end (a laparoscope) and small instruments will be used to remove the spleen.
Our Laparoscopic Surgeons
- Lawrence Damore II, MD, FACS
- Susan Cortesi, MD, FACS
- Michael Buckmire, MD, FACS, FASCRS
- Rita Hadley, MD, FACS, PHD
- Theodore Haley, MD, FACS
- Sumeet Kadakia, MD, FACS
- Matthew Marini, MD
- Kevin Masur, MD
- Richard Oh, MD, FACS
- Jennifer Reitz, MD, FACS
- Greg Rula, MD, FACS
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