Inguinal Hernia (Groin Hernia)
A hernia is the protrusion of an organ or part of an organ through an abnormal opening usually a defect in the walls of its cavity. The inguinal hernia is the result of the protrusion of the intestine into the inguinal canal and it is mainly seen in males because the inguinal canal is the path for testicular descent in the early years.
It mainly results from congenital defects of the abdominal wall, anything that increases the intraabdominal pressure or weakened abdominal musculature such as collagen deficiencies. The inguinal hernia can be of two types, direct (common in the old people) and indirect hernias (common in young people). Any hernia can strangulate.
Treatment surgery is the treatment choice for hernias is surgery, which can either be open or laparoscopic. The operation entails opening the hernial sac and reducing the contents into the abdominal cavity then fixing the internal ring of the inguinal canal to prevent a repeat of the hernia occurrence. Herniorrhaphy can also be done to repair the defects of the abdominal wall. Often these two procedures are done together. Hernioplasty is an addition operation that can be done to the herniotomy to reinforce the internal inguinal ring with a mesh fiber..
Indications
A confirmed case of an inguinal hernia-Any person with the clinical signs of a bulging inguinal canal mass that can be symptomatic or not and confirmed by radiological investigations (abdominal ultrasound) to be an inguinal hernia.
How is this procedure done?
An adult can either be put under local anesthesia, general anesthesia or even the epidural for this operation. The three types of surgeries to correct the inguinal hernia strongly depend on the age status and the fitness of the patient
- Herniotomy- this simply involves the opening the hernial sac and reducing the contents into the abdominal cavity. It is done in those whose musculature is intact such as small children. It is indicated for indirect hernias
- Herniorraphy- this involves two-steps 1. Involves the opening the hernial sac and reducing the contents into the abdominal cavity (herniotomy) and Step2. Repairing of the posterior wall of the inguinal canal. It is indicated for small hernias.
- Hernioplasty- This procedure is almost similar to the Herniorrhaphy, but instead of the repair of the posterior wall, it employs the use of a meshwork fiber to reinforce the wall. It is done in those whose musculature is sloppy especially the elderly and the debilitated. It is also indicated in large hernias.
A modern approach which is minimally invasive is through the laparoscope.
How is the procedure done
The Nissen fundoplication involves correcting the hiatal hernia by pulling the stomach back down into the abdomen, and wrapping part of the stomach around the esophagus. This allows food from the esophagus to get into the stomach, but prevents food or stomach acid from coming back up into the esophagus.
A transabdominal approach is used in which the patient lies supine on the operating table and the robotic.
Risks
One of the greatest risks of the fundoplication is that it might be intensely done such that there is an over competent lower esophageal sphincter at the entry of the esophagus into the stomach. This will, as a result, seal off any gas that is present in the stomach that it cannot go up as a belch if the patient has swallowed much air. This will result in excessive passage of flatus by the patient and discomfort caused by bloating.
How you prepare for the surgery
The patients should be thoroughly assessed if they are fit for surgery through blood workups and history and physical examinations.
The patient is required to have undergone radiological investigations such as the barium swallows to determine the extent of the underlying condition and the reports will give the surgeon a better understanding of the surgical approach that they are going to use.
The patient is then given prophylactic antibiotics before the surgery is done to prevent any infections.
As of any surgical procedure that you’ll be required to be under general anesthesia, the patient is required to fast for about 8-12 hours to avoid complications of the anesthesia.
An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.
Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.
Recovery after surgery
The recovery after the robotic post is good apart from the postoperative dysphagia (discomfort swallowing) that is experienced by some patients who have undergone is operation.
In about 3 weeks the patient should be fully healed and can go back to their normal routine and work.
Outcomes after surgery
There are limited complications associated with this type of surgery because it provides a minimally invasive approach to the treatment of the Gastroesophageal reflux disease and any underlying hiatal hernia.
It is one of the most long-lasting approaches when dealing with gastric reflux disease. A surgeon’s experience and good centers where this operation can be carried out provide better outcomes.