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Laparoscopic Incisional / Umbiliacal Hernia Repair

Hernias are abnormal protrusion of an organ or tissue through an opening that should not be there – for example the inguinal hernias found in the groin region. Incisional and umbilical hernias are hernias that result from a defect in the abdominal wall. For incisional hernias, this defect is through a weakening at the site of a surgical incision used for a previous operation. This can therefore be found anywhere on the abdominal wall. For umbilical hernias, the defect is through an opening for the umbilical cord that did fuse completely after birth.

All incisional and umbilical hernias need to be repaired by elective surgery. There is no other successful treatment for this and the hernia will only get bigger with time if left alone. Most patients will also want surgery as the hernia can cause symptoms such as discomfort, a burning sensation or a bulge. Acute complications can also happen. If the intestines get trapped in a hernia and cannot be reduced back into the abdominal cavity, it can get strangulated or obstructed. The warning signs of this happening are severe pain, vomiting and abdominal distension. Emergency surgery is then required as soon as possible.

The principles of hernia surgery are to reduce the hernia contents and to repair the hernia defect by either direct closure or by mesh reinforcement. Unless the opening is very small we prefer the mesh repair as the risk of recurrence is much lower. The operation can be done either by conventional open surgery or laparoscopically.

Instead of making a large incision over the hernia (or over the line of the previous surgical scar in the case of an incisional hernia), we make a 1 cm incision far away from the hernia to insert a telescope into the abdominal cavity. Two to three other 5 mm incisions are used to insert the instruments needed to perform the operation – the entire operation is done from within the abdominal cavity. The contents of the hernia are dissected free, reduced and a mesh is used to repair the defect. This is a special double-sided mesh, the inner lining is inert and does not adhere to the bowel which it may be in contact with. The mesh is secured with strong sutures placed in a circle around the defect and reinforced with surgical tacks.

Since the approach to the hernia is from the inside we do not need to cut through the hernia or the previous scar tissue as we would in conventional open repair. Healing is therefore much faster. There is less pain and the risk of wound infection is also reduced. The laparoscopic repair also seems to be a superior repair. In the long term, the risk of developing a recurrent incisional hernia has been found to be less than after open repair.

Most cases of Laparoscopic Repair can be done as Day Surgery or overnight admission. The only disadvantage of the Laparoscopic Repair is the high cost of the special mesh used. A medium sized piece may cost about S$1000.

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