Laparoscopy before and after surgery: what to expect?
January 4, 2023
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If diagnosed with Bilateral hernia, surgery (preferably laparoscopic) is a must.

An Overview:

Bilateral herniation refers to the presence of hernias on both sides of the body, usually in the inguinal (groin) region. This means that a hernia is present on both the left and right sides of the body. Bilateral hernias are commonly seen in men more than women.

The symptoms of bilateral herniation are similar to those of a single hernia, including a visible bulge in the groin area, pain or discomfort, and a feeling of weakness or pressure in the affected area. The treatment for bilateral hernias is typically surgical repair and the preferred modality is a laparoscopic (or keyhole) approach. With laparoscopic surgery, the surgeon can repair both sides with the same number of incisions, unlike open surgery, wherein 2 separate incisions are required in each groin. The surgeon will then reinforce the area with a mesh patch to prevent the hernia from recurring.

Recovery time can vary depending on the individual, but most people can return to normal activities within 1 week. However, there may be some restrictions and physical therapy may be needed.

It’s essential to seek medical attention if you suspect you have a hernia, as prompt treatment can prevent serious complications. Your doctor will be able to diagnose a bilateral hernia after a physical examination and may order imaging studies such as an ultrasound or CT scan to confirm the diagnosis and determine the size and location of the hernias.

What causes bilateral herniation?

A hernia is caused by a weakness or tear in the muscle or tissue that holds the abdominal organs in place. Bilateral herniation, specifically, is when a hernia occurs on both sides of the body. Some of the common causes of bilateral hernias include:

  • Genetics: Some people may be born with a predisposition to developing hernias due to inherited muscle or connective tissue weakness.
  • Straining: Heavy lifting, constipation, straining while passing urine, chronic coughing, and other activities that put a strain on muscles of the abdominal wall can lead to hernias.
  • Previous surgery: If a person has had surgery in the abdominal or groin area (especially an open appendicectomy), the muscle or tissue may be weakened, increasing the risk of developing a hernia.
  • Age: Hernias are more common as people get older and their muscles and tissues weaken.

It’s worth noting that a hernia can be present in the body without any symptoms, and the symptoms of a hernia may not appear until the hernia becomes larger or more severe.

What are the symptoms of bilateral herniation?

The symptoms of bilateral herniation can vary depending on the specific location and size of the hernias. Common symptoms of inguinal (groin) hernias, which are the most common type of hernia, include:

  1. A bulge or lump in the groin area, which may be more noticeable when standing or coughing.
  2. Pain or discomfort in the groin area, which may be sharp or dull and may be relieved by lying down.
  3. Weakness or a heavy feeling in the groin area.

If you have noticed any of the above symptoms, visit your doctor immediately.

“Also note that not all hernias cause symptoms, and some may be discovered during a physical exam or imaging study done for another reason. In some cases, if the hernia becomes trapped (incarcerated) or the blood supply is cut off (strangulated), it can cause severe pain, swelling, and discoloration of the skin. It’s an emergency and requires surgery as soon as possible.” Says Dr Harsh Sheth – a  GI laparoscopic surgeon in Mumbai, well-known in his specialized field.

The treatment procedure:

The treatment procedure for bilateral hernia in Mumbai would typically involve the following steps:

  1. Consultation with a hernia surgeon in Mumbai: The first step in treating a bilateral hernia is to schedule a consultation with a specialist doctor who is experienced in treating this condition. Your doctor will examine you and may order imaging studies such as an ultrasound or CT scan to confirm the diagnosis and determine the size and location of the hernias.
  2. Pre-operative preparations: Once the diagnosis is confirmed, you will be scheduled for surgery. Before the surgery, you will be asked to undergo certain tests such as blood tests, ECG, etc. You will also be given instructions on how to prepare for the surgery, such as fasting for a certain period of time before the procedure.
  3. Bilateral hernia surgery: The surgery is typically performed under general anesthesia, and it’s done as a day care/single day admission procedure. The surgeon makes 3-4  small incisions over the abdominal wall and places a scope into the abdomen to visualize the contents. Laparoscopic instruments are placed through the other port sites and the surgery is performed by reducing the hernia and placing a mesh to reinforce the area. The mesh is eventually covered with the peritoneum, to prevent it from touching the intestines.
  4. Post-operative recovery: After the surgery, you will be monitored in the recovery room for some time, followed by a short stay in the ward and then discharge. You will be given instructions on how to care for the surgical site and manage pain. You will also be advised to avoid heavy lifting and strenuous activity for several weeks after the surgery.
  5. Follow-up: After the surgery, you will be asked to return for follow-up appointments with your doctor to monitor the healing process and ensure that the hernia has been repaired successfully.

The hospital where the surgery is performed can be a specialized hernia surgery centre or a general hospital with a good reputation and experience in hernia surgery. Some of the well-known bilateral hernia hospitals in Mumbai are Saifee hospital in Girgaum and Wockhardt Hospital in Mumbai Central.

What is likely to happen if surgery is not done?

If surgery is not done to repair a hernia, the hernia will likely persist. It may continue to cause symptoms such as pain, discomfort, and a visible bulge in the affected area. In some cases, a hernia may become trapped (incarcerated), which means that the protruding tissue becomes stuck and cannot be pushed back into the abdominal cavity. This can cause severe pain and swelling and can be a medical emergency. If the blood supply to the trapped tissue is cut off (strangulated), it can cause the tissue to die, which can lead to severe complications such as infection, sepsis, and even death.

Without surgery, the hernia will usually not heal on its own and may continue to grow larger over time. This can lead to chronic discomfort and may make the hernia more difficult to repair surgically. Additionally, a hernia that is left untreated can also cause several complications, such as:

  • Obstruction of the intestine, which can lead to constipation, nausea, and vomiting.
  • An incarcerated hernia can lead to Ischemia of the herniated tissue, leading to loss of the herniated tissue.
  • Strangulation of the herniated tissue can lead to necrosis and sepsis.

In summary, if surgery is not done to repair a hernia, the hernia will likely persist and become more severe over time. It is essential to seek medical attention if you suspect you have a hernia, as prompt treatment can prevent serious complications.

FAQ

1What are the chances of occurrence of bilateral herniation, and is there a way to avoid herniation in the first place?

The chances of developing bilateral herniation depend on various factors, including age, sex, family history, and overall health. Men are more likely to develop bilateral inguinal hernias than women, and the risk of developing a hernia increases with age.

There is no sure way to prevent herniation, but there are certain things you can do to reduce your risk of developing a hernia:

  1. Maintain a healthy weight: Being overweight or obese can increase the pressure on your abdominal muscles and make you more susceptible to developing a hernia.
  2. Don't smoke: Smoking increases the risk of hernias by weakening the connective tissue in the body.
  3. Avoid heavy lifting: Lifting heavy objects can strain the abdominal muscles and increase your risk of developing a hernia.
  4. Practice good posture: Maintaining good posture can help reduce the pressure on your abdominal muscles and prevent hernias from forming.
  5. Avoiding constipation, as straining during a bowel movement, can increase the pressure on the abdominal muscles.
  6. Talk to your doctor about any congenital defects you may have, and if so, take precautions and avoid actions that can increase the risk of herniation.

It's important to note that even if you take steps to reduce your risk of developing a hernia, there is no guarantee that you will not develop one. If you suspect you have a hernia, it's essential to seek medical attention promptly.

2What is the most prevalent kind of herniation?

Inguinal hernias are the most prevalent type of hernias, accounting for about 75% of all hernias in adults. They occur when a portion of the intestine bulges out through a weak point in the abdominal muscles, usually in the inguinal (groin) area. Inguinal hernias are more common in men than in women. They tend to occur due to a congenital weakness in the abdominal wall or acquired weakness caused by aging, injury, or chronic strain on the abdominal muscles.

Other types of hernias include:

  • Femoral hernias: occur when a portion of the intestine bulges out through the femoral canal, which is located in the upper thigh.
  • Umbilical hernias: occur when a portion of the intestine bulges out through the umbilicus (navel). They are more common in infants and children.
  • Incisional hernias: occur when a portion of the intestine bulges out through a weak point in the abdominal wall that has developed after surgery.
  • Hiatal hernias: occur when a portion of the stomach bulges up into the chest through an opening in the diaphragm.

Inguinal hernias are the most common type of hernias. Still, other types can occur as well, and the prevalence of each type of hernia can vary depending on the population and demographic being studied.

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