One of the most common reasons individuals seek surgical medical attention is for hernia repair. Over 600,000 hernias are repaired annually in the United States alone, the majority on an outpatient basis.
Hernias commonly occur at natural openings in the body such as the umbilicus, inguinal canal or esophageal hiatus. They can also occur at sites of previous surgical incisions. When a loop of intestine or abdominal tissue pushes into the hernia sac, severe pain and other potentially serious complications can result.
There is no adequate nonsurgical medical treatment for a hernia. Under certain circumstances the hernia may be watched and followed closely by a physician. These situations are unique to those individuals who are at high risk for operation. Minimally invasive hernia surgery has been perfected in the past 2 decades. The goals are: to reduce pain, improve outcomes and reduce the time of recovery. In laparoscopic minimally invasive hernia surgery, a telescope attached to a camera is inserted through a small incision. This technique is the same whether or not robotic assistance is employed. Other small incisions are made in the abdomen.
The hernia defect is reinforced with a mesh and secured in position with stitches or staples, depending on the preference of the surgeon. The principles of surgical repair involve the use of prosthetic mesh to repair defects in order to minimize tension on the repair. A tension free repair has a lesser chance of hernia recurrence. In addition the risk of infection is markedly decreased compared to traditional open hernia repair. In fact, for inguinal hernia repairs, we can even perform the dissection in the extraperitoneal space, avoiding any intra-abdominal adhesions.
For all types of minimally invasive hernia repairs, patients are able to return to normal activity much faster. My experience with minimally invasive inguinal hernia repairs has shown that patient can even return to full athletic activity within 1-2 wks. A patient is a candidate for laparoscopic hernia repair if they are medically able to undergo the appropriate anesthesia. Also, the defect must be in an area that allows the surgeon to place the laparoscopic or robotic trocars in positions where repair is possible. In some very large hernias, the abdominal wall is distorted to such a degree that it is impossible to safely place laparoscopic instruments. Even in these cases the techniques learned with minimally invasive surgery can be applied to decrease the trauma of open repairs.
Patients with hernias should be referred to appropriately trained surgeons to assess the feasibility of minimally invasive hernia repair. Minimally invasive surgery involves laparoscopic techniques and robotic assistance may be appropriate as well.
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