Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated
CPT4 code
Name of the Procedure:
Laparoscopy for the surgical repair of ventral, umbilical, Spigelian, or epigastric hernias, including mesh insertion if performed; incarcerated or strangulated hernia repair.
Summary
Laparoscopy is a minimally invasive surgical technique used to repair hernias. This procedure involves small incisions and the use of a laparoscope (a thin tube with a camera) to repair hernias in the abdominal region. Mesh is often inserted to reinforce the repair and prevent recurrence. This specific procedure addresses hernias that are incarcerated (trapped) or strangulated (blood supply cut off).
Purpose
This procedure is performed to correct hernias in the abdominal wall, specifically ventral, umbilical, Spigelian, or epigastric hernias. The goal is to alleviate symptoms, prevent complications such as bowel obstruction or strangulation, and strengthen the affected area to prevent recurrence.
Indications
- Visible bulge or lump in the abdomen
- Pain or discomfort in the abdominal area
- Symptoms of bowel obstruction (e.g., nausea, vomiting, inability to pass gas or stool)
- Diagnosis of an incarcerated or strangulated hernia
- Failure of non-surgical treatments
- Risk factors such as obesity, previous hernia repair, or chronic cough
Preparation
- Pre-procedure fasting (typically 6-8 hours before surgery)
- Discontinuation or adjustment of certain medications as advised by the doctor
- Routine pre-operative blood tests and imaging studies, like an ultrasound or CT scan
- Anesthesia consultation
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free.
- Several small incisions are made in the abdomen.
- A laparoscope and surgical instruments are inserted through these incisions.
- The hernia is identified, and any incarcerated tissue is released.
- The hernia defect is repaired, typically using mesh to reinforce the abdominal wall.
- 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 repair.
Setting
- Hospital operating room
- Outpatient surgical center
Personnel
- General surgeon
- Anesthesiologist
- Operating room nurses
- Surgical technologists
Risks and Complications
- Infection at the incision sites
- Bleeding
- Injury to surrounding organs or tissues
- Post-operative pain or discomfort
- Hernia recurrence
- Adverse reactions to anesthesia
- Rare complications such as deep vein thrombosis or respiratory issues
Benefits
- Effective relief from hernia symptoms
- Reduced risk of complications like bowel obstruction or strangulation
- Minimally invasive approach leading to shorter recovery times
- Lower risk of infection and less scarring compared to open surgery
Recovery
- Post-procedure observation for a few hours in recovery
- Instructions for wound care and activity restrictions
- Prescribed pain medications for discomfort
- Gradual return to normal activities typically within 1-2 weeks
- Follow-up appointments to monitor healing and ensure successful repair
Alternatives
- Open hernia repair surgery
- Watchful waiting for mild cases without symptoms
Pros and Cons:
- Open surgery may be more effective for large or complex hernias but involves more extensive incisions and longer recovery times.
- Watchful waiting avoids surgery but carries risks of hernia complications worsening over time.
Patient Experience
- Patients may feel some pain and discomfort after the procedure, which is managed with medications.
- Mild bloating or soreness around the incision sites is common.
- Most patients can return home the same day or following a short hospital stay, with instructions on rest and activity limitations.