Laparoscopic Hernia is a way of treating Hernia with least risk. A hernia is the protrusion of a viscus or part of it through an abnormal opening in the wall by which it is normally contained.
CLASSIFICATION OF HERNIA
Hernias can be broadly classified as internal or external.
External hernias can occur spontaneously as a result of congenital defect or following any surgical intervention when they are called incisional hernias.
Depending upon the site of external hernia they are classified as
- Inguinal hernia which can be indirect or direct
- Femoral hernia
- Spigelian hernia
- Lumbar hernia
- Obturator hernia
- Perineal hernias
- Umbilical hernia
- Epigastric hernia Approximately 75% of all hernias are inguinal; of these, 50% are indirect (male-to-female ratio, 7:1), with a right-side predominance, and 25% are direct. About 10% of hernias are incisional or ventral
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ETIOLOGY OF HERNIA
- The etiology of most hernias can be explained on the basis of congenital defect in the body wall. However, any condition that increases the pressure in the intra-abdominal cavity may contribute to the formation of a hernia which includes the following:
- Only 3-5% of hernias are femoral
- About 14% of hernias are umbilical
- Internal hernias mostly occur after abdominal surgical intervention.
- Marked obesity
- Heavy lifting
- Straining with defecation or urination
- Peritoneal dialysis
- Chronic obstructive pulmonary disease (COPD)
PRESENTATION OF HERNIA:
The typical presentation of an asymptomatic hernia is as follows:
- Swelling or fullness at the hernial site with aching or dragging sensation
- Enlargement of the swelling with increasing intra-abdominal pressure which can result from coughing or straining.
LAPAROSCOPIC HERNIA TREATMENT:
Surgery is the only definitive treatment for the management of hernia and it is mandatory in almost all hernias because of complications which can happen in any case of untreated hernia.
Hernia surgery can be done by Open or Laparoscopic approach. A number of studies have however shown Laparoscopic repair of inguinal hernias to have many advantages over conventional open repair which includes reduced postoperative pain and early return to work.
The term laparoscopic hernia repair can refer to any of the following 3 techniques:
- Totally extraperitoneal (TEP) repair
- Transabdominal preperitoneal (TAPP) repair
- Intraperitoneal onlay mesh (IPOM) repair
COMPLICATIONS OF LAPAROSCOPIC HERNIA :
The complications of Laparoscopic Hernia Repair include haemorrhage, recurrence and adhesion formation.
Adhesion formation is more common in TAPP and IPOM. However the incidence of these complications is very low in expert hands.