What Is an Inguinal Hernia?

  • A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.
  • Both men and women can get a hernia.
  • You may be born with a hernia (congenital) or develop one over time.
  • A hernia does not get better over time, nor will it go away by itself.

How Do I Know If I Have an Inguinal Hernia?

  • The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).
  • It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.
  • The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
  • Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.

What Causes a Hernia?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

What Are the Advantages of Laparoscopic Hernia Repair?

Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a quicker return to work and normal activities with a decreased pain for some patients.

Are You a Candidate for Laparoscopic Hernia Repair?

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or underlying medical conditions.

What Preparation is Required?

  • Most hernia operations are performed on an outpatient basis, and therefore the you will probably go home on the same day that the operation is performed.
  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • It is recommended that you shower the night before or morning of the operation.
  • If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis, medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

How Is Laparoscopic Hernia Repair Performed?

There are few options available for a patient who has a hernia. Use of a truss (hernia belt) is rarely prescribed as it is usually ineffective.

Most hernias require a surgical procedure. Surgical procedures are done in one of two fashions.
I. The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.

II. The laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other cannulas are inserted which allow your surgeon to work “inside.” Three or four quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.

What Happens If the Operation Cannot Be Performed or Completed by the Laparoscopic Method?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

What Should I Expect After Laparoscopic Surgery?

  • Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
  • Once you are awake and able to walk, you will be sent home.
  • With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.
  • You are encouraged to be up and about the day after surgery.
  • With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
  • Call and schedule a follow-up appointment within 2 weeks after you operation.

What Complications Can Occur?

  • Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
  • There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
  • Difficulty urinating after surgery is not unusual and may require a temporary tube into theurinary bladder for as long as one week.
  • Any time a hernia is repaired it can come back. This long-term recurrence rate is not yet known. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.

When To Call Your Doctor

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101 degrees F (39 C)
  • Bleeding
  • Increasing abdominal or groin swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Inability to urinate
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquid

Instruction of activities after laparoscopic inguinal hernia repair

Immediately after surgery, you shall ambulate as normal as possible without restriction. The nurse will give you oral pain-killer to make you as comfortable as possible.

You can be discharge from hospital 4-6 hours after day surgery or stay overnight if necessary.

On discharge, the pain on the incision sites will be controlled with oral analgesia and the pain over incision will decrease significantly after 2 days. You will be given oral analgesia for 1 week to make you feel pain free and perform your normal activities as tolerated.

You may have some swelling over the operative site such as:

  • Seroma
  • Hematoma
  • Skin bruises
  • Superficial wound infection

Don’t worry! If you have these symptoms, you can contact the surgeon for advice.

After surgery, you shall allow to return to your normal daily activities as follow:
(Time to return to work varied widely according type of work)

  • Office work – 1 weeks
  • Manual labour work – 2 weeks
  • Time to return to driving – 1 weeks
  • Time advised before allowing sexual activities – 2 weeks.
  • Time return to sports – 12 weeks.

You will be given follow-up clinic at 2 weeks after surgery.

During follow-up clinic, the surgeon will inspect your surgical wound and check the operative sites

成人疝气之介绍

一個科技的 精緻的 人性化醫療

腹腔鏡疝氣修補手術

傷口小  疼痛少  復原快

 

定义:疝气是一个穿过腹壁肌上之晓东的突出物。(腹股沟疝气)就是在鼠蹊部的疝气。

症状:在腹股沟有不适或疼痛,尤其是走路时或工作时,在腹股沟有肿胀或摸到肿块,非   嵌顿性疝气在躺下时肿块消失

 

病因

  • 腹部压力太大,如果便秘用力˴长期咳嗽等。
  • 腹壁薄弱,如年级大因老化而导致。
  • 因幼儿时腹股沟患者内环闭合不全引起,较年轻之患者仍有可能发生。

种类:间接˴直接˴股疝气。单侧˴双侧˴复发性。

併发症:不治疗或束腹带使用需小心箝入性疝气,会造成肠坏死而危及生命。

治疗方式:手术是唯一的方式。

修补方式:传统疝气修补或腹腔镜疝气修补。

项目 传统式手术 腹腔镜手术
住院天数 1-3天 1-2天
恢复时间 4-6週 约一週
美容效果 5-10公分 三个小标记
术后疼痛 剧痛 微痛

 

腹腔镜腹股沟疝气修补的好处

  • 无张力,用人工网膜修补在腹壁内侧,类似轮胎的修补,符合力学原理。
  • 从源头治疗,可根治腹股沟疝气。
  • 仅有三个约一公分的伤口。
  • 很快痊愈,可很快回复正常活动及工作。
  • 疼痛减轻。
  • 减少其伤口的併发症,譬如感染˴血肿˴神经瘤。
  • 可同时处理两侧疝气或复发性疝气。

患者术前注意事项

  • 我们会事先告知及解释其手术前的检查。
  • 如有便秘˴呼吸道疾病,请事先告知医师。
  • 手术前一天晚上,午夜开始禁食,即无法吃或喝任何东西。
  • 请特别注意,手术前,请用肥皂将你肚脐清洗干净。
  • 手术前14天之间不要吃阿斯匹林(aspirin)或任何会导致出血的药物。
  • 手术后即进入恢复室休息再转病房。
  • 手术后需有家人陪伴,如有任何问题,请告诉我们。
  • 如果有什么问题,请跟我们讨论,不要隐瞒。

手术及停留医院时间

  • 需住院一天。
  • 此手术需全身麻醉。
  • 手术过程需一个多小时。
  • 总共呆在医院约24-48小时,于手术前三十分钟到达。

手术后卫教

疼痛:在手术后24小时内,你可能会觉得在这极小的切口有中度的疼痛,大多患者在这个时候需要止痛剂。

冷(冰)敷:手术后马上躺下来休息,拿 冰袋放在腹股沟冰敷。

淋浴: 需用防水敷料才可以淋浴。

伤口处理:这小伤口需用纱布盖上,亦可用防水敷料盖上,如果敷料掉了可用纱布盖上。

处方:手术后除了止痛剂,还会给予止咳药及软便剂,若无特殊情况,点滴在一天内拔除。

出院:手术后以下情况可以回家

  • 能下来走路而不晕眩晕
  • 开始吃或喝时不会想吐或恶心。
  • 解小便没有问题。
  • 有人带你回家。