49656 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

Name of the Procedure:

Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

Summary

This minimally invasive procedure involves repairing a recurrent incisional hernia using a laparoscope, a small instrument with a camera. During the surgery, the hernia is reduced (pushed back into place), and a mesh may be inserted to strengthen the abdominal wall.

Purpose

This procedure addresses incisional hernias that recur after previous surgeries. The goals are to reduce the hernia, prevent further recurrence, and alleviate symptoms like pain and discomfort.

Indications

• Persistent bulge or protrusion at the site of a previous surgical incision
• Pain or discomfort at the hernia site
• Previous unsuccessful hernia repairs
• Symptoms such as bowel obstruction or strangulation

Preparation

• Follow fasting instructions for at least 8 hours before the procedure.
• Stop certain medications as advised by your healthcare provider.
• Undergo preoperative assessments, including blood tests, imaging studies, and a physical examination.

Procedure Description

1. Anesthesia: The patient is given general anesthesia for comfort and pain control.
2. Incisions: Small incisions are made in the abdomen.
3. Laparoscope Insertion: A laparoscope is inserted through one of the incisions.
4. Repair: Instruments are inserted through other small incisions to locate and reduce the hernia.
5. Mesh Insertion: A mesh may be placed over the hernia defect to strengthen the abdominal wall.
6. Closure: The incisions are closed with sutures or staples.

Duration

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

Setting

The procedure is performed in a hospital or surgical center, often on an outpatient basis but may require an overnight stay.

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs
• Mesh complications (e.g., rejection or migration)
• Recurrence of the hernia
• Adverse reaction to anesthesia

Benefits

• Reduced hernia recurrence
• Relief from hernia-related pain and discomfort
• Shorter recovery time due to minimally invasive approach
• Smaller incisions leading to less scarring

Recovery

• Initial recovery takes a few days, with a full recovery in about 4 to 6 weeks.
• Follow post-operative care instructions, including wound care and activity restrictions.
• Attend follow-up appointments to monitor healing.
• Pain management via prescribed medications.

Alternatives

• Open hernia repair: Larger incision and longer recovery time.
• Watchful waiting: Monitoring the hernia without immediate surgery, only suitable if asymptomatic.
• Non-surgical management: Includes wearing a supportive belt, although this does not address the hernia itself.

Patient Experience

• During the procedure: Patient will be under general anesthesia and will not feel anything.
• After the procedure: Expect some pain and discomfort at the incision sites, manageable with pain medications.
• Gradual return to normal activities as advised by the healthcare provider, with careful adherence to lifting restrictions to prevent recurrence.