New laparoscopic procedure for hernias

Christopher Haarstad, 36, was surprised at how well he felt a couple of hours after having laparoscopic surgery for a hernia in March.

"I was a little woozy but I felt fine and the pain was less than I expected," said Haarstad, who arrived at Loyola University Hospital for surgery at 5:30 a.m., and was discharged at 11:30 a.m., the day of his procedure. "It wasn't bad at all. I even had lunch about an hour after I left Loyola."

Haarstad's experience is typical of patients who choose to have their hernias repaired laparoscopically, a relatively new, minimally invasive procedure that uses tiny incisions, special cameras and instruments and lightweight mesh patches to complete.

"This is the future of hernia surgery," said Dr. P. Marco Fisichella, the surgeon who performed Haarstad's procedure. "It's a superior, more reliable method to repair a hernia than how surgeons have traditionally repaired them in the past."

A hernia is a weakness or tear in the wall of the abdomen that can grow worse and larger over time. They can occur in men, women and children of all ages. Hernias can result from wear and tear or from abdominal defects that are present at birth. Each year, about 600,000 hernia operations are performed in the United States, according to the Society of American Gastrointestinal Endoscopic Surgeons.

Traditional surgery for a hernia requires the surgeon to make a large incision in the abdomen. Fisichella performs the laparoscopic technique using three small incisions, about the width of a dime, resulting in less pain and reduced loss of blood. He inserts a tiny camera through a small incision in order to get a three-dimensional view of the inside of the abdomen. He then inserts special surgical instruments through the incisions that he uses to cut and grip tissue and to introduce the mesh that will eventually shore up any weakness or tears in the abdominal wall.

"The total size of the incisions would be less than half inch. They're really small," said Fisichella, who is also an assistant professor, division of general surgery, Loyola University Chicago Stritch School of Medicine, Maywood.

With the traditional method, an incision is made over the site of the hernia and down through the entire defect. Fisichella places a large polyester patch on the inside of the abdominal wall, which takes advantage of the natural outward pressure of the abdomen to anchor the material in place.

"We use a large enough size of the mesh to cover all potential defects," Fisichella said. "It's like when you patch a tire. You patch a tire with a big patch. The bigger the patch, the lower is the incidence of recurrence."

Although most laparoscopic procedures take about the same amount of time as traditional surgery, recovery is generally quicker since patients don't have to care for a large incision. There is also less pain and scarring and the risk of infection is nearly zero.

The laparoscopic procedure is particularly well suited for patients with bilateral hernias, one on each side, Fisichella said. The traditional method requires the surgeon to make two incisions in order to repair the defects, resulting in a one- to two-day hospital stay. Recovery includes a significant amount of pain and healing time.

"Laparoscopically, you can repair both defects through the same incisions," Fisichella said. "So the patient sees you only once. They have anesthesia only once. There's less scarring and it's safer and utilizes fewer resources. Patients are able to eat the same day, there are no dietary restrictions and we're able to send them home right away."

In some instances - obesity, excessive scarring from previous surgeries, bleeding issues - traditional hernia surgery may not the best procedure for some patients, Fisichella said. It's best to discuss your options with your surgeon.

SOURCE Loyola University Hospital