What Is The Likelihood Of Re Injuring A Repaired Hernia
Inguinal hernia repair
Definition
Inguinal hernia repair, also known as herniorrhaphy, is the surgical correction of an inguinal hernia. An inguinal hernia is an opening, weakness, or bulge in the lining tissue (peritoneum) of the abdominal wall in the groin area betwixt the abdomen and the thigh. The surgery may be a standard open process through an incision large enough
This patient has an indirect inguinal hernia (A). To repair it, the surgeon makes an incision over the area and separates the muscle and tisses to betrayal the hernia sac (B). The sac is cut open up (C), and the contents are replaced into the abdomen (D). The neck of the hernia sac is tied off (E), and the muscles and tissues are sutured (F). (
Illustration by GGS Inc.
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to access the hernia or a laparoscopic procedure performed through tiny incisions, using an instrument with a photographic camera attached (laparoscope) and a video monitor to guide the repair. When the surgery involves reinforcing the weakened area with steel mesh, the repair is chosen hernioplasty.
Purpose
Inguinal hernia repair is performed to close or mend the weakened abdominal wall of an inquinal hernia.
Demographics
The bulk of hernias occur in males. Nearly 25% of men and only 2% of women in the United States will develop inguinal hernias. Inguinal hernias occur nearly three times more ofttimes in African American adults than in Caucasians. Amidst children, the risk of groin hernia is greater in premature infants or those of low birth weight. Indirect inguinal hernias volition occur in x–20 children in every 1,000 live births.
Description
Virtually 75% of all hernias are classified as inguinal hernias, which are the most common type of hernia occurring in men and women as a result of the activities of normal living and crumbling. Considering humans stand upright, there is a greater downward force on the lower abdomen, increasing pressure level on the less muscled and naturally weaker tissues of the groin area. Inguinal hernias do non include those caused by a cut (incision) in the abdominal wall (incisional hernia). According to the National Centre for Health Statistics, almost 700,000 inguinal hernias are repaired annually in the United States. The inguinal hernia is normally seen or felt first as a tender and sometimes painful lump in the upper groin where the inguinal canal passes through the abdominal wall. The inguinal canal is the normal route by which testes descend into the scrotum in the male fetus, which is one reason these hernias occur more frequently in men.
Hernias are divided into two categories: congenital (from birth), also called indirect hernias, and acquired, as well called direct hernias. Among the 75% of hernias classified as inguinal hernias, 50% are indirect or congenital hernias, occurring when the inguinal canal entrance fails to shut usually before nascence. The indirect inguinal hernia pushes down from the abdomen and through the inguinal canal. This condition is found in two% of all adult males and in 1–two% of male children. Indirect inguinal hernias tin can occur in women, likewise, when abdominal force per unit area pushes folds of genital tissue into the inquinal canal opening. In fact, women will more likely take an indirect inguinal hernia than direct. Direct or acquired inguinal hernias occur when function of the large intestine protrudes through a weakened area of muscles in the groin. The weakening results from a multifariousness of factors encountered in the wear and tear of life.
Inguinal hernias may occur on one side of the groin or both sides at the same or different times, but occur most ofttimes on the right side. Most 60% of hernias found in children, for example, will exist on the right side, well-nigh 30% on the left, and 10% on both sides. The muscular weak spots develop because of pressure on the abdominal muscles in the groin area occurring during normal activities such every bit lifting, coughing, straining during urination or bowel movements, pregnancy, or excessive weight gain. Internal organs such as the intestines may then push through this weak spot, causing a bulge of tissue. A congenital indirect inguinal hernia may be diagnosed in infancy, babyhood, or later in adulthood, influenced by the same causes as direct hernia. At that place is evidence that a tendency for inguinal hernia may be inherited.
A direct and an indirect inguinal hernia may occur at the same time; this combined hernia is called a pantaloon hernia.
A femoral hernia is some other type of hernia that appears in the groin, occurring when abdominal organs and tissue press through the femoral ring (passageway where the major femoral artery and vein extend from the leg into the belly) into the upper thigh. About 3% of all hernias are femoral, and 84% of all femoral hernias occur in women. These are non inquinal hernias, but they can sometimes confuse the diagnosis of inguinal hernias because they curve over the inguinal expanse. They are more than often accompanied past intestinal obstruction than inguinal hernias.
Because inguinal hernias do not heal on their own and can go larger or twisted, which may close off the intestines, the prevailing medical stance is that hernias must be treated surgically when they cause hurting or limit activity. Protruding intestines can sometimes be pushed back temporarily into the abdominal cavity, or an external support (truss) may be worn to hold the area in place until surgery tin be performed. Sometimes, other medical conditions complicate the presence of a hernia by adding abiding intestinal pressure. These conditions, including chronic coughing, constipation, fluid retention, or urinary obstruction, must be treated simultaneously to reduce abdominal pressure and the recurrence of hernias after repair. A relationship between smoking and hernia evolution has too been shown. Groin hernias occur more oft in smokers than nonsmokers, especially in women. A hernia may become incarcerated, which ways that information technology is trapped in place and cannot slip back into the abdomen. This causes bowel obstruction, which may require the removal of afflicted parts of the intestines ( bowel resection ) every bit well every bit hernia repair. If the herniated intestine becomes twisted, claret supply to the intestines may be cut off (intestinal ischemia) and the hernia is said to be strangulated, a condition causing astringent hurting and requiring immediate surgery.
Surgical procedures
In open inguinal hernia repair procedures, the patient is typically given a calorie-free general anesthesia of brusque duration. Local or regional anesthetics may be given to some patients. Open surgical repair of an indirect hernia begins with sterilizing and draping the inguinal expanse of the belly just above the thigh. An incision is made in the intestinal wall and fatty tissue removed to betrayal the inguinal canal and define the outer margins of the pigsty or weakness in the muscle. The weakened section of tissue is dissected (cutting and removed) and the inguinal canal opening is sutured closed (main closure), making sure that no abdominal organ tissue is inside the sutured area. The exposed inguinal canal is examined for whatever other trouble spots that may need reinforcement. Closing the underlayers of tissue (subcutaneous tissue) with fine sutures and the outer skin with staples completes the procedure. A sterile dressing is then applied.
An open repair of a direct hernia begins just every bit the repair of an indirect hernia, with an incision fabricated in the aforementioned location higher up the thigh, just large enough to let visualization of the hernia. The surgeon volition await for and palpate (touch on) the bulging expanse of the hernia and volition reduce it by placing sutures in the fatty layer of the intestinal wall. The hernial sac itself will be airtight, as in the repair of the indirect hernia, past using a series of sutures from one end of the weakened hernia defect to the other. The repair will be checked for sturdiness and for any tension on the new sutures. The subcutaneous tissue and peel will exist airtight and a sterile dressing applied.
Laparoscopic procedures are conducted using general anesthesia. The surgeon will make iii tiny incisions in the intestinal wall of the groin area and inflate the abdomen with carbon dioxide to expand the surgical expanse. A laparoscope, which is a tube-like fiber-optic musical instrument with a minor video camera attached to its tip, will exist inserted in one incision and surgical instruments inserted in the other incisions. The surgeon will view the movement of the instruments on a video monitor, equally the hernia is pushed back into place and the hernial sac is repaired with surgical sutures or staples. Laparoscopic surgery is believed to produce less postoperative pain and a quicker recovery fourth dimension. The take chances of infection is also reduced because of the small incisions required in laparoscopic surgery.
The use of surgical (prosthetic) steel mesh or polypropylene mesh in the repair of inguinal hernias has been shown to help prevent recurrent hernias. Instead of the tension that develops between sutures and the skin in a conventionally repaired area, hernioplasty using mesh patches has been shown to virtually eliminate tension. The procedure is oft performed in an outpatient facility with local anesthesia and patients tin can walk away the aforementioned day, with little restrictions in activeness. Tension-free repair is as well quick and easy to perform using the laparoscopic method, although general anesthesia is ordinarily used. In either open up or laparoscopic procedures, the mesh is placed so that information technology overlaps the healthy skin around the hernia opening and and so is sutured into identify with fine silk. Rather than pulling the hole closed as in conventional repair, the mesh makes a bridge over the hole and every bit normal healing take place, the mesh is incorporated into normal tissue without resulting tension.
Diagnosis/Preparation
Diagnosis
Reviewing the patient's symptoms and medical history are the first steps in diagnosing a hernia. The surgeon will ask when the patient first noticed a lump or bulge in the groin expanse, whether or not information technology has grown larger, and how much pain the patient is experiencing. The physician will palpate the area, looking for whatsoever aberrant bulging or mass, and may enquire the patient to cough or strain in order to see and feel the hernia more easily. This may exist all that is needed to diagnose an inguinal hernia. To confirm the presence of the hernia, an ultrasound examination may be performed. The ultrasound scan will let the doctor to visualize the hernia and to make sure that the burl is not some other type of abdominal mass such equally a tumor or enlarged lymph gland. It is not commonly possible to determine whether the hernia is direct or indirect until surgery is performed.
Preparation
Patients will have standard preoperative claret and urine tests, an electrocardiogram, and a chest x ray to make sure that the centre, lungs, and major organ systems are operation well. A week or so before surgery, medications may be discontinued, especially aspirin or anticoagulant (claret-thinning) drugs. Starting the night before surgery, patients must not eat or drink anything. Once in the infirmary, a tube may be placed into a vein in the arm (intravenous line) to deliver fluid and medication during surgery. A sedative may exist given to relax the patient.
Aftercare
The hernia repair site must be kept clean and any sign of swelling or redness reported to the surgeon. Patients should as well study a fever, and men should written report whatever hurting or swelling of the testicles. The surgeon may remove the outer sutures in a follow-upwardly visit almost a week after surgery. Activities may exist limited to non-strenuous motion for upwardly to 2 weeks, depending on the blazon of surgery performed and whether or non the surgery is the first hernia repair. To let proper healing of musculus tissue, hernia repair patients should avoid heavy lifting for half dozen to eight weeks after surgery. The postoperative activities of patients undergoing repeat procedures may be even more restricted.
Prevention of indirect hernias, which are congenital, is non possible. However, preventing direct hernias and reducing the take chances of recurrence of straight and indirect hernias can be accomplished by:
- maintaining trunk weight suitable for age and height
- strengthening abdominal muscles through regular practise
- reducing intestinal pressure level by avoiding constipation and the build-upwardly of excess trunk fluids, achieved by adopting a high-cobweb, low-salt diet
- lifting heavy objects in a safe, low-stress way, using arm and leg muscles
Risks
Hernia surgery is considered to exist a relatively prophylactic procedure, although complication rates range from 1–26%, most in the 7–12% range. This means that virtually ten% of the 700,000 inguinal hernia repairs each year will have complications. Sure specialized clinics written report markedly fewer complications, oftentimes related to whether open or laparoscopic technique is used. I of the greatest risks of inquinal hernia repair is that the hernia will recur. Unfortunately, x–xv% of hernias may develop again at the same site in adults, representing about 100,000 recurrences annually. The run a risk of recurrence in children is only about one%. Recurrent hernias tin present a serious problem considering incarceration and strangulation are more likely and because boosted surgical repair is more difficult than the first surgery. When the first hernia repair breaks down, the surgeon must piece of work effectually scar tissue as well as the recurrent hernia. Incisional hernias, which are hernias that occur at the site of a prior surgery, present the same circumstance of combined scar tissue and hernia and even greater risk of recurrence. Each time a repair is performed, the surgery is less likely to be successful. Recurrence and infection rates for mesh repairs accept been shown in some studies to exist lower than with conventional surgeries.
Complications that can occur during surgery include injury to the spermatic cord construction; injuries to veins or arteries, causing hemorrhage; severing or entrapping nerves, which can cause paralysis; injuries to the float or bowel; reactions to anesthesia; and systemic complications such as cardiac arrythmias, cardiac arrest, or death. Postoperative complications include infection of the surgical incision (less in laparoscopy ); the germination of blood clots at the site that tin travel to other parts of the body; pulmonary (lung) problems; and urinary retentiveness or urinary tract infection.
Normal results
Inguinal hernia repair is usually effective, depending on the size of the hernia, how much time has gone by between its start advent and the corrective surgery, and the underlying status of the patient. Most first-fourth dimension hernia repair procedures will exist one-mean solar day surgeries, in which the patient will go home the aforementioned mean solar day or in 24 hours. But the most challenging cases will crave an overnight stay. Recovery times will vary, depending on the type of surgery performed. Patients undergoing open up surgery will feel little discomfort and will resume normal activities within one to 2 weeks. Laparoscopy patients volition be able to savour normal activities within ane or 2 days, returning to a normal work routine and lifestyle within four to seven days, with the exception of heavy lifting and contact sports.
Morbidity and mortality rates
Mortality related to inguinal hernia repair or postoperative complications is unlikely, but with avant-garde age or severe underlying conditions, deaths practise occur. Recurrence is a notable complication and is associated with increased morbidity, with recurrence rates for indirect hernias from less than 1–7% and 4–x% for direct.
Alternatives
If a hernia is not surgically repaired, an incarcerated or strangulated hernia can upshot, sometimes involving life-threatening bowel obstacle or ischemia.
Resources
books
Maddern, Guy J. Hernia Repair: Open vs. Laparoscopic approaches. London: Churchill Livingstone, 1997.
organizations
American College of Surgeons (ACS), Office of Public Information. 633 Due north Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. http://www.facs.org .
The National Digestive Diseases Information Clearinghouse (NIDDK). 2 Data Way, Bethesda, Physician 20892-3570. http://world wide web.niddk.nih.gov/wellness/digest/nddic.htm .
other
"Focus on Men'south Health: Hernia." MedicineNet Home January. 2003. http://www.medicinenet.com .
"Inguinal Hernia." Healthwise, Inc. February 2001. http://www.laurushealth.com/library. .
L. Lee Culvert
WHO PERFORMS THE Procedure AND WHERE IS IT PERFORMED?
Inguinal hernia repair is performed in a hospital operating room or i-twenty-four hours surgical facility past a full general surgeon who may specialize in hernia surgery.
QUESTIONS TO ASK THE DOCTOR
- What procedure will be performed to correct my hernia?
- What is your experience with this procedure? How often do you perform this process?
- Why must I have the surgery now rather than waiting?
- What are my options if I do not have the surgery?
- How can I expect to experience after surgery?
- What are the risks involved in having this surgery?
- How quickly volition I recover? When can I return to schoolhouse or piece of work?
- What are my chances of having another hernia?
Source: https://www.surgeryencyclopedia.com/Fi-La/Inguinal-Hernia-Repair.html
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