Laparoscopic surgery
Laparoscopic surgery
Operation
– Exemption and physical activity
Surgery is performed through small incisions. CO2 gas is injected into the abdominal cavity to create space to perform the hernia repair. Three small holes are created through which ports (trocarts) are inserted. A trocart (port) is a cylinder made of metal or hard plastic placed through the abdominal wall. Instruments necessary to perform the operation are inserted through the trocarts. At least two 5mm and one 10mm trocarts are inserted. In the first stage, the hernia sac is freed of its contents. The content consists in most cases of fatty tissue or bowel.
The fatty tissue attached to the abdominal wall is removed to obtain better adhesion of the mesh against the wall. The mesh usually has a diameter of 12 to 15 cm. It is rolled up like a cigarette leaf and inserted into the abdominal cavity through the 10 mm trocart. The mesh (prosthesis) is fixed to the abdominal wall with absorbable sutures (3-4 threads) and staplers. The trocarts are removed from the abdominal wall and the skin is closed with non-visible sutures (intra-dermo). The abdominal wall is closed with a separate stitch at the level of the 10 mm trocart. This suture can be the the most sensitive postoperatively.
What is a biphasic prosthesis/mesh?
A biphasic mesh has 2 sides. An upper side of polypropylene silk. Scar tissue will form through and around the openings in the mesh/prosthesis, causing it to be incorporated into the adjacent tissue. This forms a mechanical barrier against pressure and prevents hernia recurrences.
A smooth side on the bowel side that reduces the risk of the prosthesis adhering and growing into the bowel.
If the prosthesis infects and does not respond to antibiotic treatment, it may be necessary to remove the prosthesis / mesh.
A prosthesis is made of polypropylene with the following characteristics :
Over time, scar tissue forms through and around the mesh of the prosthesis causing it to grow into the adjacent tissue, so to speak. Thus, it forms a mechanical barrier against pressure and against the formation of a new hernia.
If the prosthesis infects and does not respond to antibiotic treatment, it may need to be removed.
How long does the procedure take?
Depending on the size of the defect, the procedure takes 40 to 90 minutes.
What should one do to prevent a hernia recurrence after surgery?
For the first 6 weeks after surgery, do not play sports or engage in strenuous physical activities.
Avoid being overweight, as this increases intra-abdominal pressure and therefore the risk of a hernia recurrence.
Incidence : < 4%
Risk factors promoting recurrence:
Rare : < 1%
Incidence : < 2 – 4 %, very rare
Incidence : < 6%
If a large hernia is removed or if part of the hernia sac remains in, the void left after treatment of the hernia may be filled with abdominal fluid (seroma) and blood.
The fluid collection can be emptied by punctures during the consultation, rarely the fluid has to be removed surgically.
Incidence : +/-9%
< 1,5% when adhesions between bowels and the sac are loosened.
Rare, mostly due to bleeding from small vessels on the abdominal wall. In most cases, the bleeding stops spontaneously.
To reduce the risk of complications, it is advisable to :
In normal conditions, pain is well controlled with paracetamol (Dafalgan®), NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time.
If certain symptoms seem abnormal to you contact your doctor
If this is not possible, you can contact avec your surgeon.
If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.
Pregnancy is always possible after open umbilicus/epigastric hernia repair with mesh or prosthesis.