Surgeons resort to this surgery when the inguinal hernia causes severe pain or is particularly severe.
Since the operation requires anesthesia (local, spinal or general), the patient is required to follow some simple instructions, such as, for example, go fast on the day of the operation.
There are two modes of intervention: the traditional surgery procedure ("open") and the laparoscopic procedure.
Barring complications, the patient is discharged the same day as the operation and, after a couple of weeks, can resume lighter daily activities.
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An "inguinal hernia is the leakage, at the level of the groin and precisely in the direction of the so-called inguinal canal, of an abdominal viscus; this leakage is due to a collapse of the muscular wall of the lower abdomen (abdominal wall) and determines the formation of a localized swelling, sometimes even clearly visible.
The bowel that most commonly causes an inguinal hernia is the intestine; however, it is not excluded that the bladder or a portion of adipose tissue (which is not really an organ, but can still reside close to the inguinal canal) may leak out.
The exact location of the swelling varies according to where the bowel reaches, inside the inguinal canal. In this regard, it is appropriate to remind readers that what the inguinal canal is: it is an anatomical structure, similar to a duct, which crosses the entire anterior abdominal wall and inside which the blood vessels pass through the human body. of the spermatic cord and, in women, the round ligament of the uterus.
When present, the symptoms of an inguinal hernia consist mainly of: suffering, pain and a sense of tension, all three corresponding to the swelling.
Inguinal hernia: how widespread is it?
The inguinal hernia is by far the most common type of hernia.
Men suffer the most, since they have, compared to women, an inguinal canal that is anatomically more predisposed to the escape of the abdominal viscera.
To get an idea of how widespread inguinal hernia is in males, it is thought that, according to various statistical researches, more than 25 out of 100 men suffer from this disorder at least once in their life.
Inguinal hernia is typical of middle-aged adults but can also occur in children and the elderly.
During the clinical investigations and the evaluation of the clinical history, the patient has the opportunity to speak with the surgeon who will perform the operation (or with a member of his staff), so as to inquire about the methods of intervention, the possible risks, behaviors to follow before and after the procedure, and recovery times.
Inguinal Hernia Operation: Pre-operative Recommendations
- 10-14 days before inguinal hernia surgery, stop any treatment based on antiplatelet agents (aspirin), anticoagulants (warfarin) and anti-inflammatory drugs (NSAIDs), because these drugs, by reducing the clotting capacity of the blood, predispose to severe loss of blood.
- On the day of the procedure, go on a complete fast for at least the previous evening.
- For the day of the operation, ask for the availability of a trusted person (eg family member or close friend) to be assisted, especially after the operation and on returning home.
- If you are a smoker, stop smoking at least until the wound has healed completely.
Why is Clinical History Important?
Evaluating a patient's medical history means questioning him to find out, for example, if he knows he is allergic to some anesthetic drug, if he suffers or has suffered in the past from cardiovascular problems, if he is taking certain drugs and if, in the case of a woman, he is pregnant.
This information is valuable, because it allows you to better plan the procedure.
Attention
Those suffering from diabetes or other diseases that require constant "drug intake are required to inform the surgeon of their condition, so that the latter can make the appropriate changes to the standard procedure."
Each method has its own advantages and disadvantages. The illustration to the patient of the pros and cons obviously takes place before the operation and it is usually the operating surgeon who takes care of it.
Figure: Inguinal hernia before and after surgery. From cfmis.com
Regardless of the method used, the inguinal hernia surgery lasts from 30 to 45 minutes. Once completed, there is an observation period lasting several hours: in this period, both the medical staff and the surgeon monitors the health conditions and vital parameters of the operated patient step by step.
If no complications arise, discharge takes place on the day of the operation (if the procedure took place in the morning, the patient is usually discharged in the late afternoon).
"Strangled" inguinal hernia
In the event of a "constriction", the surgeon must remove the "constricted" (therefore lifeless) section of intestine and surgically rejoin the separated ends.
After the "strangled" inguinal hernia operations, a 4-5 day hospitalization is foreseen.
Traditional inguinal hernia surgery
Once transported to the operating room, the patient is anesthetized so that he does not feel pain. Anesthesia can be local, spinal or general.
In the case of local or spinal anesthesia, the subject to be operated on remains conscious for the entire duration of the operation; on the contrary, in the case of general anesthesia, the individual to be operated on is asleep.
Once the anesthesia has taken place, the actual operation begins; the traditional procedure includes:
- A "skin incision of 6-10 centimeters at where" the hernia appeared,
- The repositioning of the leaked bowel in its natural location
- The application of a net made of biocompatible material (eg: polypropylene) in the point where the abdominal wall has undergone collapse. This net made of biocompatible material has the purpose of containing the bowels which, otherwise, would tend to come out again; in other words , is a sort of "patch" (in English, in fact, it is called patch).
Once the application of the wire mesh has been completed, the surgeon closes the incision with several sutures, which are usually resorbable (ie they fall by themselves, once the wound has healed).
Inguinal Hernia Surgery in Laparoscopy
Laparoscopy (or Video-Lapar-Surgery - VLC) is a minimally invasive surgical technique, thanks to which the operating doctor can access the abdominal cavity and pelvic cavity of a patient, without resorting to the large incisions required by traditional "sky surgery" open".
Representation of inguinal hernia surgery by laparoscopy; note the small openings necessary to introduce the surgical instruments. From the site: inguinalherniatreatment.co.uk
The laparoscopic incisions, in fact, measure only one centimeter, which is sufficient to introduce the surgical instruments necessary - in the case in question - for the repositioning of the leaked viscera and for the "patch" by means of the net in biocompatible material discussed for the " intervention in "open air" mode.
The anesthesia provided in the case of laparoscopy is of a general type, therefore the patient is completely unconscious.
Surgeons have the possibility to perform the surgery laparoscopically with two different approaches:
- By the preperitoneal transabdominal route
- Totally extraperitoneal way
Inguinal Hernia Operation: What Is the Best Surgical Technique?
Experts believe that, from the point of view of advantages and disadvantages, the two intervention methods are equivalent. In fact:
- Wounds following the laparoscopy operation heal much faster, as the surgical incisions are small.
- With an "open" operation, however, the risk of damaging the intestine through surgical instruments is lower. This is due to the fact that, during a laparoscopy, the surgeon follows his own movements inside the abdominal cavity on a monitor and not directly, as with the open procedure.
What affects the choice of the intervention method?
The factors that affect the choice of the intervention method are essentially two: the patient's state of health - who, if he is healthy and not elderly, can "handle" general anesthesia (therefore laparoscopy) - and the experience of the surgeon in a specific operating method.
(or a pain reliever).Personal hygiene
Doctors recommend maximum personal hygiene to reduce the risk of infection. All useful information on how to wash without wetting the dressings and how to keep wounds clean are explained by the medical staff at the time of discharge.
Inguinal Hernia Intervention: Recovery Times
The return to normal daily activities must be gradual and must take place according to the sensations felt; in other words, it is good not to force recovery and, if you feel pain while you are making a certain effort, stop immediately.
Generally, for the resumption of lighter daily activities, it is sufficient to wait 1-2 weeks, while for the resumption of heavier activities, it is necessary to wait from 4 to 6 weeks.
The return to work depends on the work itself: if the patient performs sedentary work, 1-2 weeks of rest are enough; if, on the other hand, the patient carries out manual work, it takes several more weeks, sometimes even 6.
To resume driving, it is advisable to wait until sitting at the wheel no longer creates any pain or discomfort.
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