Laparoscopic Abdominal Hernia Surgery
What is Hernia?
A hernia occurs when the internal organs of the abdominal cavity push through a weakened spot in the abdominal wall to form a bulge. Hernias occur most commonly between the area of your rib cage and groin. Abdominal hernias may include hiatal hernia, incisional hernia and umbilical hernia.
Hiatal hernia is a condition in which part of the stomach slides through the hiatus, an opening in the diaphragm, and protrudes into the chest. Hiatal hernia is a common condition and commonly affects people over 50 years of age.
An incisional hernia is the bulge that develops from a previous abdominal surgical scar that causes weakness in the abdominal area. Incisional hernias can occur with a few types of abdominal surgeries. Poor healing of the surgical incisions or pressure on the scars may cause a bulge to develop months or years after the surgery.
Umbilical (Paraumbilical) Hernia
Umbilical (paraumbilical) hernia is the bulge that forms near the navel or belly button, when a part of the intestine, fat or fluid is pushed out through a weakened muscle of the abdomen. Umbilical hernia can be found in both children and adults.
Symptoms of Abdominal Hernia
Some of the commonly observed symptoms of hiatal hernia include chest pain, heart burn, belching and difficulty in swallowing.
The first symptom of an incisional hernia is pain near the scar formed from a prior surgery. The site may or may not show a bulge. Symptoms may be more noticeable when the size of the bulge increases. Some other symptoms include:
- Pressure and fullness in the abdomen
- Pain and discomfort while bending or lifting
- Swelling near the incisional site which disappears after lying down (reducible hernia)
- Feeling of something being present in the incisional site
- Burning sensation
The main symptom of an umbilical hernia is the presence of a swelling or bulge near the navel which ranges from about 1 to 5 cm in diameter.
Diagnosis of Abdominal Hernia
To diagnose abdominal hernia, your doctor will enquire about your symptoms and your medical history. Physical examination is generally conducted for determining the size and prominence of the umbilical hernia. Your bulge will be examined when you are standing and lying down. Your doctor may try to reduce the bulge by pushing it inside your abdomen and will ask you to cough to see if there is any change in size of the bulge.
Imaging tests such as X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) scan may be ordered to determine that part of the internal organ that is protruding into the bulge.
Blood tests may be ordered to confirm a strangulated hernia by checking the white blood cell and red blood cell count. Infection, inflammation, tissue death or bleeding can be detected with blood tests.
Your doctor may order the following tests to diagnose hiatal hernia:
- Barium swallow test: involves swallowing a barium preparation, which can be detected through X-rays.
- Endoscopy:allows your doctor to examine the inside of your oesophagus and stomach with an instrument called an endoscope, a thin flexible lighted tube.
Treatment for Abdominal Hernia
Your doctor may suggest a hernia belt (truss) which compresses the bulge back into its proper place and reduces it. Surgery is not necessary for treating a small incisional hernia. However, a large painful hernia that is growing in size requires surgical repair.
Treatment may not be necessary if you are not experiencing symptoms. Treatment is usually started when you experience symptoms such as severe heartburn, when the oesophagus gets inflamed due to acid reflux, the hiatus narrows, or lungs are inflamed. Your doctor prescribes medications and suggests lifestyle changes to treat heartburn and acid reflux.
Surgery is recommended if medications do not help in relieving symptoms, although it is rare. Laparoscopic Nissen fundoplication (LNF) is considered the standard of care for hiatal hernia.
In adults, a painful and enlarged bulge is usually treated with surgery. Surgery can prevent further complications of the hernia such as strangulation. However, in children, the hernia generally resolves by 18 months.
Your doctor may wait for a while before suggesting surgery. Your surgeon may perform either an open surgery or a keyhole surgery (laparoscopy) for repairing the umbilical hernia. Laparoscopy may be recommended if the hernia has reappeared after a prior surgery. Your surgeon will make two to three small incisions away from the bulge and insert a laparoscope (a fibre-optic tube with a light source and camera attached to it) and other special instruments through the incisions. The bulge will be pushed into the abdominal cavity, and the abdominal wall will either be stitched, or a mesh will be placed to support the weak part of your abdominal wall.