Blog : The way of painless and quick recovery in Hernia Surgery

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Laparoscopic Surgery changed the world of Surgeons, patients and surgery forever when Dr Muhe and Dr Mouret first did a Gall bladder surgery without opening the Abdomen by putting a telescope and long handle instruments inside the abdomen through tiny punctures.

Soon Dr Arregui did the first laparoscopic repair on Inguinal Hernia and Dr LeBlanc did similar repair of a Ventral (Umbilical ) Hernia laparoscopically.

Below are two pictures of how laparoscopic surgery is performed through tiny punctures. The inner view of hernia is seen on a screen. The surgery is done with long instruments put inside: the surgeon holds the handles of these instruments outside the abdomen and looks at the screen and operates with hands using the instrument handles outside the abdomen.

The principle of hernia repair is to reduce the contents of hernia back to abdomen and then repair the defect of hernia by covering it with a synthetic Mesh, which is much larger than the size of the defect.

If this patch of Mesh is placed from inside rather than outside, the intra-abdominal pressure holds it against the abdominal wall and provides a more secure cover with less chances of recurrence. This mesh is then fixed using screws of special metal or bio-absorbable material. Hernia laparoscopic surgeryOn the left is a picture of open surgery and on the right is how the mesh is fixed from inside onto the hernia defect.

Benefits and advantages:
Laparoscopic repair of hernias offers several benefits to the patient:
1. No open big incision on the Abdomen, since the surgery is done through small puncture holes.
2. Larger size of mesh can be spread and fixed on the defect from inside
3. Short hospital stay of one or two days.
4. Minimal pain of surgery.
5. no bedrest is required.
6. Early return to work as early as three to five days.
7. All types of work, exercise or lifting of weights can be done after few days to weeks later.
7. Minimum medicines required.
8. Cosmetically good results are achieved.

Limitations of surgery:
1. Very large hernias are not amenable to laparoscopic surgery.
2. Very bad skin with Ulcers or infection may have to be removed through open surgery.
3. Needs General Anaesthesia.
4. Higher technical expertise required.
5. Costs of surgery are high because of high costs of mesh and disposables.: Ventral Hernia needs a special mesh which has a layer to prevent intestines sticking to the mesh: this makes the mesh very costly, and the fixation of this mesh also needs a disposable device contains screws ( Tacks).
6. Very large and wide defects may need special techniques of Component separation surgery for closure of defects.

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