Hernia Repair

The approach depends on the hernia type, size, and patient condition:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Clinical exam: A reducible bulge that increases with coughing or straining (Valsalva maneuver).
     • Ultrasound or CT scan confirms the diagnosis for complex or unclear cases (e.g., incisional, hiatal).
     • Blood tests assess fitness for surgery (e.g., hemoglobin, coagulation).
   • Patients are advised to stop smoking (reduces recurrence risk) and lose weight if obese.
   • Blood thinners (e.g., aspirin) are stopped 5–7 days prior to reduce bleeding risk.
   • Bowel preparation may be needed for hiatal or large incisional hernias.
2. Surgical Techniques:
   
   • Open Hernia Repair:
     
     • Performed under general, spinal, or local anesthesia, lasting 45–90 minutes.
     • Inguinal/Femoral Hernia (e.g., Lichtenstein Repair):
       
       • A 5–10 cm incision is made over the groin.
       • The hernia sac is identified, reduced (pushed back), or excised if non-viable.
       • The defect is closed with sutures, and a synthetic mesh (e.g., polypropylene) is placed to reinforce the area.
       • The incision is closed in layers.
     • Umbilical/Incisional Hernia:
       
       • Incision over the hernia site; similar steps with mesh placement for larger defects (>2 cm).
   • Laparoscopic Hernia Repair:
     
     • Preferred for bilateral inguinal hernias, recurrent hernias, or in fit patients; performed under general anesthesia, lasting 60–120 minutes.
     • Transabdominal Preperitoneal (TAPP):
       
       • Three small incisions (0.5–1 cm) in the abdomen.
       • The abdomen is inflated with CO2 gas; a camera and instruments are inserted.
       • The hernia sac is reduced, and a mesh is placed in the preperitoneal space to cover the defect.
     • Totally Extraperitoneal (TEP):
       
       • Mesh placed without entering the peritoneal cavity, reducing adhesion risk.
     • Incisions are closed with glue or sutures; often a day procedure.
   • Hiatal Hernia Repair (e.g., Nissen Fundoplication):
     
     • Laparoscopic approach; the stomach is reduced, the hiatus is tightened, and the stomach is wrapped around the esophagus to prevent reflux.
   • Emergency Repair:
     
     • For strangulated hernias, an open approach is used; bowel resection may be needed if the tissue is non-viable.
3. After Surgery:
   
   • Patients are monitored for a few hours (laparoscopic) or 1–3 days (open/emergency).
   • Pain is managed with analgesics (e.g., paracetamol, ibuprofen); shoulder pain (from CO2) may occur in laparoscopic cases.
   • Antibiotics are rarely needed unless infection or bowel resection occurred.
   • A soft diet starts within 6–12 hours; patients are encouraged to walk early to prevent blood clots.

• Surgical Risks: Bleeding (1–2%), infection (1–3%, higher in open), seroma/hematoma (2–5%).
• Post-Surgical Complications:
  • Recurrence (1–5% with mesh, 10–15% without).
  • Chronic pain (5–10%, due to nerve irritation or mesh).
  • Mesh complications: Infection (1–2%), migration (rare).
• General Risks: Anesthesia reactions, blood clots (DVT, <1%).
• Long-Term: Testicular pain/swelling (inguinal, 1–3%), bowel obstruction (incisional, 1–2%).

Report fever, severe pain, or swelling promptly.