LAPAROSCOPIC VENTRAL HERNIA REPAIR

Nowadays, the number of ventral hernia repairs using laparoscopy has increased,especially if they are recurrent injures that have previously been intervened withtraditional open surgery.

A few small incisions are done and through them a mesh is introduced with thelaparoscope in order to cover the hernia orifices in the abdomen. Thus, the recoveryis much faster.

1.- What does ventral hernia or eventration consistof?

It is a tear or separation of the muscles where a previous surgical incision was made which results in a protrusion of the peritoneum and the intestinal viscera.

Another weak point in the abdomen is the umbilical region, where umbilical herniaappears. Hernias do not disappear by themselves, and the only possible treatment is a surgical intervention.

2.-How do I know if I have a ventral hernia?

You will notice a "bulge" under your skin or in the old surgical wound that increaseswhen you cough and disappears when you lie down. You may notice some pain andhave nausea and vomits. In case the latter happens, you must go to the Emergencyservices because you may present a strangulated ventral hernia.

3.- What cases ventral hernia?

The most frequent cause is a previous surgical intervention, especially if there were any complications in the wound like an infection, suppuration, or hemorrhages. It can be present at all ages, but it is more frequent with age and especially if anyassociated illnesses are present, like chronic bronchitis.

4.- What are the advantages of the laparoscopic repair?

Through a few small incisions, gas is introduced in the abdomen and then the herniacan be repaired with a mesh that is fixed to the abdominal muscles with specialstaples. Thanks to laparoscopy, the recovery is faster and less painful, so the patient can get to their normal life (except for physical exercise) in 7-10 days after the intervention, and they can be discharged from hospital 12-24 hours after the intervention.

5.-When is laparoscopic surgery indicated?

Your surgeon will only be able to determine if you are a candidate for this procedureafter performing certain tests.

It depends on the type and shape of the hernia, as certain hernias are very difficultto treat with a laparoscopic approach. Patients are different and the surgeon will indicate the appropriate technique for each case.

6.-What preparations are required?

Most patients need a basic preoperative preparation: blood test, chest x-ray, and electrocardiogram for the anesthesia team. In case the patient presents any associated illness some special tests may be necessary.

The day before the intervention, it will be necessary to proceed with thoroughpersonal hygiene every 12 hours. It is convenient to carry out a cleaning enema 12hours before the intervention.

Complete fasting (LIQUIDS INCLUDED) 6 hours prior the intervention is alsonecessary.

The patient will inform their surgeon about the medicines they are taking before theintervention. For example, it is necessary to stop taking any drug that alters clotting(like aspirins or Sintrom) and substitute them for others that the doctor will decide.

Sometimes it can be necessary to take antibiotics before the intervention to preventpossible infections. Your doctor will advise it beforehand.

7.- How does the procedure take place?

Three conditions are stated before surgery: - Compression systems (girdles) are not indicated before surgery. - The hernia does not disappear on its own. - Surgery is not the only solution.

In case you are candidate for the laparoscopic approach, a few small incisions will be made on your abdomen (under general anesthesia). Through them, an optical TVdevice will be introduced and it will liberate the adhesion formations from yourprevious intervention. Besides, a mesh will be introduced in order to cover the hernia orifices and it will be fixed to the abdominal wall muscles using special staples andstitches. Sometimes it will be necessary to leave drainages in order to suck anyremaining liquid to prevent it from accumulating itself inside the abdomen or the hernial protrusion.

8.- What happens if laparoscopy is not feasible?

The intervention will be done with open surgery performing an incision in theabdominal region where the hernia is located.

It is not a laparoscopic complication but a decision that the surgeon takes in order to ensure the most adequate or indicated technique for each patient. Proceeding withopen surgery is based exclusively on the security of the patient.

9.- What happens after the surgical intervention?

After surgery, you will stay for 1-2 hours in a room to recover from the anesthesiaand then you will be taken to your room, where you will be able to take liquids andsolid food progressively.

When you can walk, you will be discharged from hospital, but will be able to movefrom the very same intervention day.

If the reparation has been done laparoscopically, you can get to your normal life in7-10 days (except for physical exercise).

You will have to visit the doctor 10 days after to get the stitches removed. Thesecond checkup will take place after 15 days and the last one 30-40 days after the intervention. The patient will then be able to do physical exercise.

10.- What complications may arise?

They are infrequent, but hemorrhages, infections, or injuries in abdominal viscera (bowel, urinary bladder) may appear. The latter are the most infrequent of them all,but they must be mentioned due to their complexity.

We cannot ensure 100% that the hernia will not appear again, but thanks to the useof the mesh, the chances of a relapse have decreased considerably.

Some patients feel a "hardening" of the area where the hernia was. This is caused bythe cicatricial reaction of the mesh when it is in contact with the surrounding structures. However, this situation will normalize again in time.

11.- When should I call the doctor?

- Temperature over 38º - Hemorrhage - Increasing abdominal pain - Incapability to urinate - Reddening or suppuration of the wound - Respiratory symptoms like persistent coughing or costal pain

Fax: +34 91 750 04 55

General surgery appointment telephone number: +34 91 756 79 00. Ext:4136

Outpatient appointment telephone number: +34 91 756 79 00 / 902 10 74 71

Hospital telephone number: +34 91 756 78 00