49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible

Name of the Procedure:

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

Summary

A laparoscopy for the surgical repair of an incisional hernia involves using small incisions and a camera to guide the surgical process. Surgeons fix the hernia and often use mesh to reinforce the abdominal wall. The procedure is minimally invasive and suitable for hernias that can be pushed back into place.

Purpose

This procedure addresses incisional hernias, which occur at the site of a previous surgical incision. The goals are to relieve discomfort or pain, prevent the hernia from becoming irreducible (trapped outside the abdominal wall), and reduce the risk of complications such as bowel obstruction and strangulation.

Indications

• Presence of a noticeable bulge or swelling at the site of a previous surgical incision.
• Pain or discomfort at the hernia site.
• Symptoms like nausea, vomiting, or difficulty with bowel movements.
• Hernias that can be manually pushed back into the abdomen (reducible).

Preparation

• Patients are usually advised to fast for 8-12 hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Preoperative assessments might include blood tests, imaging studies like an ultrasound or CT scan, and a physical examination.

Procedure Description

1. Small incisions are made in the abdominal area.
2. A laparoscope (a thin tube with a camera) is inserted to provide visual guidance.
3. Surgical instruments are inserted through additional small incisions.
4. The hernia is carefully reduced (pushed back into place).
5. Mesh may be placed over the hernia site to strengthen the abdominal wall.
6. The incisions are closed with sutures or surgical glue.

Tools and equipment used include laparoscopes, trocars, surgical mesh, and specialized laparoscopic instruments. General anesthesia is administered for patient comfort and immobility during the procedure.

Duration

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

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a general or laparoscopic surgeon)
• Anesthesiologist
• Surgical nurses and assistants
• Operating room technicians

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma formation
• Injury to surrounding organs (e.g., intestines, bladder)
• Anesthesia-related risks
• Recurrence of the hernia
• Chronic pain at the surgical site
• Seroma (fluid collection)

Benefits

• Reduction of hernia-related pain and discomfort
• Decreased risk of hernia complications like strangulation
• Improved quality of life
• Minimally invasive approach leads to smaller scars, less postoperative pain, and quicker recovery compared to open surgery

Recovery

• Patients may be discharged the same day or require an overnight stay.
• Postoperative instructions include avoiding heavy lifting and strenuous activities for several weeks.
• Pain management may involve prescribed medications and over-the-counter pain relievers.
• Follow-up appointments to monitor healing and ensure no complications.

Alternatives

• Open hernia repair surgery
• Watchful waiting for asymptomatic or minimally symptomatic hernias Each alternative has its pros and cons, including differences in recovery times, risks, and potential for recurrence.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel or remember the surgery. Postoperatively, discomfort is expected but managed with medications. Most patients can resume normal activities within a few weeks, though full recovery might take longer. Pain management and comfort measures are prioritized to ensure a smooth recovery.