49655 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

Name of the Procedure:

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated.

Summary

This procedure involves repairing a hernia that has formed at the site of a previous surgical incision. Using a minimally invasive technique called laparoscopy, surgeons use small incisions and special tools to access and repair the hernia, often placing a mesh to reinforce the abdominal wall. This specific procedure is used when the hernia is incarcerated (trapped) or strangulated (cutting off blood supply), necessitating urgent intervention.

Purpose

The procedure addresses incisional hernias, which are hernias occurring at the site of a prior surgical incision. The goals are to relieve symptoms such as pain or discomfort, prevent complications like bowel obstruction or tissue death, and restore normal function and appearance to the abdominal area.

Indications

• Presence of an incisional hernia from a previous surgery.
• Symptoms like pain, swelling, or bulging at the hernia site.
• Evidence that the hernia is incarcerated or strangulated, causing severe pain or symptoms of bowel obstruction.
• Failure of other conservative treatments to provide relief or manage the condition.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments or temporary discontinuation of certain medications, especially blood thinners.
• Pre-operative assessments such as blood tests, imaging studies (ultrasound, CT scan), and a physical examination.

Procedure Description

1. The patient is administered general anesthesia.
2. Small incisions are made near the hernia site.
3. A laparoscope (a thin tube with a camera) is inserted through one of the incisions to provide a visual guide.
4. Special surgical instruments are inserted through other small incisions to repair the hernia.
5. If necessary, mesh is placed to strengthen the abdominal wall and prevent recurrence.
6. The instruments are removed, and the incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the hernia.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon specialized in laparoscopic procedures.
• Anesthesiologist and anesthetic support staff.
• Operating room nurses and surgical technicians.

Risks and Complications

• Infection at the incision sites.
• Bleeding or blood clots.
• Injury to surrounding organs or tissues.
• Recurrence of the hernia.
• Adverse reactions to anesthesia.
• Chronic pain at the repair site.

Benefits

• Relief from hernia-related pain and discomfort.
• Reduced risk of complications like bowel obstruction or tissue death.
• Strengthened abdominal wall, decreasing the likelihood of hernia recurrence.
• Faster recovery and less post-operative pain compared to open surgery.

Recovery

• Patients can usually go home the same day or the following day.
• Light activities are recommended initially, with a gradual return to normal activities over a few weeks.
• Pain management includes prescribed medications and advice on wound care.
• Follow-up appointments to monitor recovery and ensure the hernia repair is healing properly.

Alternatives

• Open incisional hernia repair: More invasive, longer recovery time, but beneficial for certain patients.
• Non-surgical options: Often limited to symptom management and are not suitable for incarcerated or strangulated hernias.

Patient Experience

• Patients may feel groggy and experience some pain or discomfort post-surgery, which is managed with pain medication.
• Mobilization is encouraged soon after the procedure to promote healing and prevent complications.
• Most patients return to their normal routine within a few weeks, with full recovery in about 4-6 weeks.