49657 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

Name of the Procedure:

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

Summary

Laparoscopic repair of a recurrent incisional hernia involves minimally invasive surgery to fix a hernia that has reappeared at the site of a previous surgical incision. The procedure is done using small incisions, a camera, and specialized instruments. It often includes the insertion of mesh to strengthen the repaired area, particularly in cases where the hernia is trapped (incarcerated) or cutting off blood supply (strangulated).

Purpose

This procedure addresses recurrent incisional hernias, which occur at the site of a prior surgical incision where the abdominal wall has weakened. The goal is to alleviate pain, prevent complications, and restore the integrity of the abdominal wall.

Indications

• Recurrent incisional hernia that is causing pain, discomfort, or digestive issues.
• Hernias that are incarcerated or strangulated, posing a risk to blood supply or leading to bowel obstruction.
• Failure of non-surgical treatments and necessity for repair to prevent further complications.

Preparation

• Patients typically need to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-procedure diagnostic tests such as blood tests, imaging studies (e.g., CT scans), or physical exams are often required.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted through one of the incisions to view the internal structures.
4. Additional instruments are introduced through the other incisions to repair the hernia.
5. The herniated tissue is pushed back into place.
6. Mesh may be placed over the hernia site to reinforce the area and prevent recurrence.
7. The instruments are removed, and the incisions are closed with sutures or staples.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity of the hernia.

Setting

Laparoscopic hernia repair is performed in a hospital operating room or a specialized surgical center.

Personnel

• General surgeon or laparoscopic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Common risks: infection, bleeding, and pain at the incision sites.
• Rare risks: injury to surrounding organs, hernia recurrence, and adverse reactions to anesthesia.
• Management of complications may involve additional treatments or surgeries.

Benefits

• Minimally invasive with smaller incisions, leading to reduced post-operative pain and quicker recovery.
• Lower risk of infection and complications compared to open surgery.
• Effective repair with reduced chance of hernia recurrence.

Recovery

• Most patients can go home the same day or after an overnight hospital stay.
• Instructions include wound care, activity restrictions, and pain management.
• Full recovery typically occurs within a few weeks, but heavy lifting or strenuous activities should be avoided for several months.
• Follow-up appointments are necessary to monitor healing.

Alternatives

• Open hernia repair: Involves larger incisions and a longer recovery time but may be necessary for complex cases.
• Non-surgical options: Wearing a hernia belt or watchful waiting, which may not be effective for incarcerated or strangulated hernias.
• Pros and cons depend on the severity and specific patient conditions.

Patient Experience

Patients will be under general anesthesia during the procedure, so they will not feel any pain. Post-surgery, they may experience mild to moderate pain at the incision sites, managed with prescribed pain medication. Discomfort typically lessens within a few days, and most patients can resume normal activities within a few weeks, following medical advice.