Herniorrhaphy is a term used for surgical repair of a hernia by suturing.
What is Inguinal Herniorrhaphy?
Open hernia repair is a surgical procedure in which a single long incision is made in the groin. In a direct type, in which the hernia is bulging out of the abdominal wall, the bulge is pushed back into its proper place. On the other hand, in the indirect type , the hernia is going down the inguinal canal then the hernia sac is pushed back or removed.
Inguinal Herniorrhaphy Procedure
To diagnose hernia it is important to first review the patient’s symptoms and medical history. The patient will then be asked by the surgeon for the presence of bulge in the groin area, its size and the intensity of pain the patient is experiencing. The doctor will assess the area through palpation to check for mass or lump, and the patient may be instructed to cough or strain so that it will be easier to see and feel the abnormality. Moreover, an ultrasound examination should be done to confirm the presence of hernia. The ultrasound scan will help the doctor to visualize the hernia and the extent of the disease. The surgery is performed to determine if the hernia is direct or indirect.
Before the surgical procedure is done, standard preoperative assessment is done to make sure that the patient is physically ready. This includes, blood and urine test, electrocardiogram and chest X-ray. Certain medications like anti-coagulants should be discontinued a week or so before the scheduled surgery. Patients are instructed not to eat or drink anything a night before the operation. Once admitted in the hospital, an intravenous line will be place into a vein in the arm to administer fluid and medication during the surgery. A sedative will also be given as a relaxant.
Surgical procedure of Herniorrhaphy
Prior to the surgery, a light general, local or regional anaesthetic is administered to the patient.
- In the indirect type of hernia the inguinal area of the abdomen just above the thigh is sterilized and draped.
- The abdominal wall is incised to expose the inguinal canal and check the weakness of the muscle. The weakened area of the tissue is cut and removed (dissected) and the hole in the inguinal canal is sutured to close. The surgeon has to make sure that no abdominal organ is present in the sutured area.
- The exposed inguinal canal is thoroughly examined for any trouble sites that may need reinforcement. The subcutaneous tissue is then closed using fine sutures and the outer skin with staples completes the procedure. A sterile dressing is then applied.
- For the open repair of direct hernia the surgery begins just the same with the repair of an indirect hernia. Incision is also made in the same area above the thigh.
- The surgeon will assess for bulging in the area through palpation and will reduce it by putting sutures in the fatty layer of the abdominal wall. Just like the repair of the indirect hernia, the hernia sac will be closed utilizing a series of sutures from one end of the defective hernia to the other.
- The repair will be assessed for the intactness of the new sutures. The subcutaneous tissue and skin will be sutured and a sterile dressing is applied.
Laparoscopy is another procedure and general anaesthesia is used. It is through the use of a laparoscope, a tube-like fibre-optic instrument with a small video camera attached to its tip.
- The surgical area is expanded by three small incisions in the abdominal wall of the groin area and abdomen is inflated with carbon dioxide.
- A laparoscope is then inserted in one incision and surgical instruments are inserted in the other incisions. The surgeon will see the movement of the instruments on a video monitor, as the hernia is pushed back into place and the hernia sac is repaired with surgical sutures or staples. It is believed that laparoscopic surgery produce less postoperative pain and a quicker recovery time.
- The risk of infection is also lesser because of the small incisions required in laparoscopic surgery.
Hernioplasty. Another type of procedure is the uses of surgical prosthetic like steel mesh or polypropylene mesh to repair of inguinal hernias and it has been tested 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 substantially eradicate the tension.
- This procedure is usually performed in an outpatient facility using local anaesthesia and patients can be discharged from the facility the same day, with lesser restrictions in activity.
- Tension-free repair is also quick and easy to perform using the laparoscopic method, although general anaesthesia is often used. In either open or laparoscopic procedures, the mesh is used so that it overlaps the healthy skin around the hernia opening and then is sutured into place with fine silk.
- The mesh acts as a bridge over the hole rather than pulling the hole close. Finally, as normal process of healing takes place; the mesh is incorporated into normal tissue without causing tension.
Post Operative Care
It is important to keep the hernia repair site clean and any untoward signs in the surgical site like pain, swelling, redness and other signs of infection such as fever should be reported to the physician immediately. A week after the surgery, the surgeon may remove the outer sutures and that will also be a follow up visit of the client. Non-strenuous activities are indicated for up to two weeks, depending on the type of surgery performed and whether or not the surgery is the first hernia repair. To promote proper healing of muscle tissue it is a must that hernia repair patients should avoid lifting heavy objects for six to eight weeks after surgery.
There is no way to avoid indirect hernias that are congenital. Nevertheless, preventing direct hernias and decreasing the risk of recurrence of direct and indirect hernias can be successfully accomplished thru the following ways:
- body weight should be maintained suitable for age and height
- regular exercise should be done like strengthening abdominal muscles
- avoid constipation and the build-up of excess body fluids to reduce abdominal pressure, have a high-fiber, low-salt diet
- use arm and leg muscles to lift heavy objects
Risks and Complications
Hernia surgery is indeed a safe procedure, yet complication rates range from 1–26%, most in the 7–12% range. This means that about 10% of the 700,000 inguinal hernia repairs each year will have complications. Highly innovative clinics report only fewer complications and sometimes related to whether open or laparoscopic technique is done.
Recurrence of hernia. One of the greatest risks of inguinal hernia repair is the recurrence of hernia. Sad to say that according to research, 10–15% of hernias may develop again at the same site in adults, representing about 100,000 recurrences annually. The risk of recurrence in children is minimal to only about 1%. Recurrent hernias are considered as a serious problem because incarceration and strangulation are more likely to happen and that additional surgical repair is harder than the first surgery. When the first hernia repair is broken, the surgeon must work around scar tissue as well as the recurrent hernia. There is greater risk of recurrence in incisional hernias; these are hernias that occur at the site prior to surgery. The surgery is less likely to be successful each time a repair is performed. Recurrence and infection rates for mesh repairs have been shown in some studies to be lesser than with conventional surgeries.
There are numbers of complications that can occur during surgery like
- injury to the spermatic cord structure;
- injuries to veins or arteries, leading to haemorrhage; severing or entrapping nerves, which can cause paralysis;
- injuries to the bladder or bowel;
- reactions to anaesthesia; and
- systemic complications such as cardiac arrhythmias, cardiac arrest, or death.
- postoperative complications include infection of the surgical incision which is less likely to occur in laparoscopy;
- the formation of blood clots at the site that go freely to other parts of the body;
- pulmonary (lung) problems; and
- urinary retention or urinary tract infection
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