About Hernia

A hernia is diagnosed when an internal organ protrudes through a weak spot in your muscle or tissues. In typical scenarios, the inner organ pushes through the wall of muscles or tissues. Usually, hernia affects the abdominal cavity, i.e. between the chest and the hips.

Diagnosis & Evaluations Before Laparoscopic Hernia Surgery

Diagnosing a hernia involves identifying its severity through a combination of physical exam, medical history review, and imaging tests and determining the most suitable approach for hernia repair. The initial evaluation process involves the following:

• Physical Exam: The Surgeon will palpate the affected area to look for signs of a hernia, such as a bulge or a lump. The patient may be asked to cough or strain, which can make the hernia more noticeable. During the physical exam, the Surgeon may also try to gently push the hernia back into place to see if it is reducible(it can be pushed back into the abdominal cavity through the opening). This helps to determine the severity of the hernia and whether surgery is needed.
• Medical History: The patient needs to provide a detailed medical history, including when the symptoms started and the factors that aggravate the pain and other symptoms. The Surgeon may also ask if the patient has had any previous surgeries. Other questions may also be asked about the patient’s overall health, age, and existing medical conditions.

After the assessment, the Surgeon may recommend several imaging tests to confirm the diagnosis and plan the surgery accurately. Some common hernia tests include the following:

• Ultrasound: This test uses sound waves to create images of internal structures. It helps to determine the size and location of the hernia along with the contents of the hernia sac.
• CT Scan: A computed tomography scan provides detailed cross-sectional images of the affected area to identify the type of hernia, its size, and whether the surrounding structures are affected by it.
• MRI (Magnetic Resonance Imaging): This test provides detailed images of the soft tissues and helps to evaluate the extent of herniation.

Besides these imaging tests, some additional tests, such as pulmonary function tests, cardiac evaluation, ECG/EKG, etc., may also be done to ensure that the patient is in optimal health. The results of these tests and evaluations allow the surgeon to identify the potential risks and complications of surgery and the safest approach for hernia repair.

Management and Treatment Options for Hernia

The various management and treatment options for hernia include the following:

• Watchful Waiting: For small, symptomatic hernias, a “wait and see” approach is recommended, which involves regular monitoring of the bulge to ensure it doesn’t become larger or more problematic. It is preferred in elderly patients with multiple health issues.
• Lifestyle Modifications: Making certain lifestyle changes can also help to manage hernia symptoms, especially hiatal hernias. These may include avoiding large meals, staying upright after eating, etc.
• Medications: The Surgeon may prescribe over-the-counter or prescription medications to alleviate the symptoms associated with hernias, such as acid reflux or heartburn.
• Support Garments: For some individuals, the Surgeon may recommend wearing a hernia truss or support garments to push back the bulging organ in the abdominal cavity. However, it is not a long-term solution, and patients should not use them without consulting a Surgeon.
• Hernia Repair Surgery: Surgical repair for hernia is mostly recommended when the condition is symptomatic and there are significant risks of developing complications. The primary goal of surgery is to push back the protruding organ or tissue into its proper place. In most cases, the abdominal wall is strengthened using a hernia mesh, which also helps to prevent hernia recurrence.

The most suitable method of Laparoscopic Hernia Surgery is determined based on factors such as the type of hernia, its size, symptoms, the patient’s overall health, and the preferred choice of Surgery.

Surgical Techniques for Hernia Repair

There are two types of hernia surgery (hernia surgery name): one is herniorrhaphy (tension repair), and the other is hernioplasty (mesh repair). Herniorrhaphy refers to repairing the abdominal wall without any support. Hernioplasty refers to repairing the wall with the help of hernia mesh which acts as a reinforcement. Nowadays, in most cases, hernioplasty is performed to repair hernias, and this approach is also called tension-free hernia repair.

Surgery on Hernia can be performed using the following techniques:

• Open Hernia Surgery: This is a standard technique for Laparoscopic Hernia Surgery where the surgeon makes an incision in the skin to access the herniated tissues and places them back in the abdominal cavity. Once the repair is done, the surgeon stitches the edges of the healthy tissues together to close the opening in the abdominal wall. A more common approach involves placing a synthetic mesh over the weakened area of the abdominal wall to provide support and prevent recurrence. The mesh is sewn in place or secured with surgical staples.
• Laparoscopic Hernia Surgery: In laparoscopic hernia operations, the surgeon may take a totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approach. In TEP, the hernia is repaired from outside the wall without entering the peritoneal cavity. In the transabdominal approach, the surgeon enters the peritoneal cavity and places a mesh inside to reinforce the abdominal wall. Both these approaches are minimally invasive as only keyhole-sized incisions are created to access the hernia, and a laparoscope is used, which provides live, high-quality video feed of the internal organs. This technique has minimal complications and higher success rates than open hernia surgery.
• Robotic Hernia Surgery: This technique is quite similar to laparoscopic hernia surgery, but instead of performing the surgery directly, the surgeon uses robotic arms for enhanced dexterity and precision. The robotic technique is very helpful in treating hernias in children.

Each surgical approach has its advantages and considerations. The choice of technique depends on the type of hernia, the surgeon’s expertise, and the patient’s preference.

Comparative Analysis of Open, Laparoscopic and Robotic Hernia Surgery

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Benefits of Laparoscopic Hernia Surgery

Commonly called keyhole surgery, laparoscopic hernia surgery is a minimally invasive procedure that offers several benefits over conventional open hernia surgery. The key benefits include the following:

• Smaller Incisions: The laparoscopic technique requires only 2-3 small incisions, which are less than an inch. Smaller incisions result in less tissue damage, reduced scarring, and better cosmetic outcome.
• Minimal Pain & Blood Loss: Due to the smaller size of incisions and reduced tissue manipulation, patients experience less post-operative pain and bleeding during and after the procedure compared to open surgery.
• Faster Recovery: Laparoscopic hernia surgery generally involves shorter hospital stays and faster Laparoscopic Hernia Surgery Recovery Time as it is minimally invasive. Most patients can resume normal activities within a couple of weeks after a hernia operation.
• Reduced Risk of Infection: The smaller incisions in this technique also reduce the exposure of internal tissues to the external environment and contaminants, thereby lowering the risk of infection significantly.
• Lower Risk of Hernia Recurrence: There is a higher risk of hernia recurrence in open surgery as it may or may not involve using mesh. However, with laparoscopic hernia surgery, a mesh is often used to reinforce the wall, which prevents the organ from protruding again. The small incisions also reduce further trauma to the abdominal wall, which lowers the risk of incisional hernia.
• Shorter Hospital Stay: In most patients, laparoscopic hernia repair surgery is performed on an outpatient basis, which means that an overnight hospital stay is usually not required after the surgery. Thus, the patient can go home on the same day after a few hours of observation.
• Quickly Resume Work & Other Activities: While open hernia surgery makes it difficult for the patient to return to work and perform other activities, laparoscopic repair allows them to resume work and other activities within 1-2 weeks. As there is a reduced risk of tearing the stitches and strain in the treated area, the patient can perform basic activities without worrying about the pain.
• Improved Cosmetic Outcome: Thanks to smaller incisions, the scarring after laparoscopic hernia repair is minimal. Once these scars heal, they also become almost unnoticeable

While laparoscopic hernia operation is highly beneficial for patients, it should be noted that it may not be suitable for all hernia types and in certain medical conditions.

Preparation Before Laparoscopic hernia surgery

The surgeon provides detailed instructions to prepare the patient for a hernia operation. While the instructions can vary based on individual circumstances, some common guidelines the patient may receive include the following:

• The patient needs to get all the recommended tests done before the surgery and keep the reports with them during admission.
• It’s also important for the patient to disclose information about the current medications, including prescription and over-the-counter drugs and supplements. The Surgeon will adjust the medications or suggest temporarily stopping certain medications before surgery.
• The patient needs to avoid eating or drinking anything for a specified period before the surgery to prevent complications during anesthesia administration and surgery.
• The Surgeon will provide an antibacterial soap on the day of surgery to reduce the risk of infection.
• The patient is advised to avoid taking medicines, such as aspirin, ibuprofen, or other blood-thinning medications, as they can increase the risk of excessive bleeding during the surgery.
• Since general anesthesia is used for hernia repair, the patient will not be able to drive back home. He/she will be advised to ask a friend or family member to drive or use other means of transportation.
• The patient is advised to wear loose and comfortable clothes on the day of surgery and avoid wearing jewellery, makeup, and other accessories.
• The Surgeon will also instruct the patient to stop smoking and drinking in the days leading up to the surgery, as they can affect the body’s response to anesthesia and impair healing abilities.

Before proceeding with the surgery, patients are encouraged to ask questions and clarify their doubts so that they have a better understanding of the procedure, risks, benefits, and other aspects of Laparoscopic Hernia Surgery.

What Happens During Hernia Operation?

The steps of hernia operation vary depending on the type of hernia and the approach used for repair. The choice of technique is usually dictated by the type of hernia, its size, and location. In general, there can be several risks with both conventional open surgery as well as the modern laparoscopic approach. So, unless there are some underlying factors at play, the following techniques of surgery are likely preferred-

• Femoral hernia – Open Surgery
• Inguinal hernia – Laparoscopic or Open
• Umbilical hernia – Open
• Ventral / Incisional hernia – Laparoscopic
• Hiatal hernia- Laparoscopic

In case a hernia is large and has been bothering the patient for a long time, the open procedure may be preferred over the laparoscopic technique.

In general, a hernia operation is carried out in the following steps:

• Before taking the patient to the operating room (OR), they are asked to sign a consent form. The patient is prepped for the surgery, which includes changing into a hospital gown and having an IV line inserted (mostly in the arm) for fluids and medications.
• An anesthetist will administer anesthesia carefully, which will put the patient to sleep. The right type of anesthesia is determined based on the patient’s medical history. In most cases, general anesthesia is used.
• Once the patient is unconscious and numb, the surgeon will make the required number of incisions near the hernia site, depending on the technique chosen. In open hernia repair, a single large incision is made. In laparoscopic hernia repair, 2-4 small incisions are made to insert the surgical instruments and laparoscope (camera). In laparoscopic and robotic repair, carbon dioxide gas is used to inflate the abdominal cavity to create ample space for the surgeon to work.
• The surgeon will gently push the protruding tissue or organ back into its proper position within the abdominal cavity.
• A synthetic mesh may be used for the surgery. This hernia mesh acts as a reinforcement for the weakened area. The mesh is either placed over the hernia defect from the outside (called an onlay) or positioned beneath the defect or perforation in the abdominal wall and surrounding muscles (called sublay or preperitoneal). The mesh is secured with sutures, staples, or tissue glue as suitable.
• Once the repair is done, the incisions are closed with absorbable sutures, adhesives, or surgical tape. In case of open surgery, standard staples or sutures will be used to close the incisions. The incision site will also be covered with gauze or bandages.
• The patient will then be transferred to the recovery area, where the nurses will monitor his/her vital signs until the effects of anesthesia wear off.

The entire procedure takes around 40 to 60 minutes. If open hernia repair is done, the patient will need to stay in the hospital for 1-2 days. In the case of laparoscopic and robotic repair, the patient can be discharged on the same day after surgery.

What to Expect After Laparoscopic hernia surgery?

Immediately after hernia surgery, the patient can expect to experience a combination of effects from the anesthesia, surgery, and the body’s response to the procedure.

Some general things that can be expected on the day of surgery include the following:

• The patient will feel disoriented due to the effects of anesthesia even after it wears off. There will be drowsiness, grogginess, confusion, and nausea temporarily.
• There will be significant pain and discomfort in and around the surgical site. Pain medications will be given to the patient through the IV line. The severity of pain will vary based on the surgical approach and the patient’s pain tolerance.
• In some cases, the patient can expect to find drainage tubes in the treated area, which are used to allow drainage of excess fluid in the surgical site. The drains will be removed within 1-2 days.

After ensuring that the patient’s vitals are stable, the Surgeon will give permission to discharge. Before sending the patient home, detailed post-op wound care instructions, diet tips, precautionary tips, and a follow-up schedule are provided to the patient. The post-op experience of each patient will be different depending on the complexity of their specific case.

Laparoscopic Hernia Surgery Complications & Side Effects

Hernia surgery is usually safe and effective. But like any other surgical procedure, it carries potential risks and complications. The surgeon usually takes the necessary measures to reduce the risks and complications. However, in emergency cases, it may not be possible to mitigate them all.

Some potential complications and side effects of hernia operation include the following:

• Infection: An infection may occur at the surgical site due to poor hygiene or wound care. Signs of infections include increased pain, redness, swelling, warmth, and discharge from the incisions. If any of these symptoms present, it’s advised to contact the Surgeon promptly.
• Bleeding: While bleeding is normal after surgery, in some cases, the patient may experience excessive bleeding during or after the surgery.
• Hematoma & Seroma: Blood accumulation and fluid accumulations are often after surgical procedures. In some cases, they resolve on their own. But in others, drainage may be required to prevent further complications.
• Mesh-related Complications: In some cases, the patient may experience an allergic reaction to the mesh or issues like mesh migration, mesh shrinkage, or adherence to nearby tissues. If such complications arise, the Surgeon may have to remove the mesh.
• Recurrence: Despite successful repair, hernias can sometimes recur, especially if the mesh is not placed for scaffolding. Along with this, Laparoscopic hernia surgery also makes the patient vulnerable to incisional hernia.

Besides all these, there are several other complications, such as adhesion formation due to abnormal healing, chronic pain in the surgical site, wound dehiscence, anesthesia reactions, etc., that may occur after hernia surgery. To prevent these risks, complications, and side effects of anesthesia, the patient needs to follow the pre and post-op instructions strictly for a smooth and successful Laparoscopic Hernia Surgery Recovery Time.

Laparoscopic Hernia Surgery Recovery Time

The Laparoscopic Hernia Surgery Recovery Time is approximately 3 to 6 weeks. The exact duration for each patient will vary depending on their healing abilities, type of surgery, and whether the patient complies with the post-surgery care instructions.

If the patient has open hernia surgery, the Hernia Surgery Recovery Time will be around 4 to 6 weeks. But with laparoscopic hernia surgery, recovery time will be 3 to 4 weeks. The general recovery timeline will be as follows:

• On the Day of Surgery: The patient will spend the first few hours after surgery in the recovery room and will experience pain and discomfort, which will be managed through pain medications. Once the effects of anesthesia wear off, the patient will be allowed to drink clear fluids and progress to a regular diet as tolerated. Depending on the type of surgery, the patient may get discharged on the same day or require overnight hospitalization.
• In the First Week: Pain and discomfort will gradually improve, but the patient will likely need to continue taking pain medications as prescribed. The Surgeon will advise you to take it easy, avoid heavy lifting, and rest properly to allow the body to heal. The patient will have to keep the incision area clean to prevent infections.
• In 2-3 Weeks: In case of laparoscopic hernia operation, the patient will be able to resume most activities and can even go back to work within 2-3 weeks. However, with open surgery, the patient will only be allowed to return to normal activities, such as walking or gentle stretching. He/she will have to continue monitoring the incisions and avoid bathing in tubs, swimming, and strenuous activities.
• In 3-6 Weeks: Most people can resume normal activities within three to six weeks. Patients can resume school or work, given that the job doesn’t involve heavy lifting or strenuous activities. The Surgeon will guide the patient about when it’s safe to resume strenuous exercises and activities.

After 6 weeks and beyond, patients are usually able to resume most activities, including exercises and heavy lifting. The incision will be well-healed, but there will be minor discomfort and tightness in the scar. At this time, the Surgeon may recommend using scar reduction cream to improve the skin’s appearance. It’s important to listen to the body and gradually increase physical activity to avoid overexertion. Follow the surgeon’s instructions and report if any sign of infection or complications appears.

Lifestyle Changes Recommended After Laparoscopic hernia surgery

Hernia patients should understand that after Laparoscopic hernia surgery, they will have to make certain lifestyle changes to contribute to their recovery and prevent complications and recurrence. Individuals will have to take several precautions after hernia surgery for a smooth and successful recovery and follow the tips below:

• For a certain period after hernia surgery (usually 3-4 weeks at least), avoid lifting heavy objects or exercising, as such activities can put undue pressure or strain on the surgical site. The patient is also advised to be very careful lifting heavy objects in the future too, as the integrity of the abdominal muscle wall is already compromised.
• Instead of pushing the body to perform activities, even walking or climbing stairs, allow the body to heal at its own pace and gradually resume activities. If it hurts performing any activity, stop immediately. Pushing the body to its limit during the recovery period can lead to complications, such as tearing of stitches, mesh displacement, etc.
• Though it is a general recommendation, the patient should primarily focus on taking a balanced diet after hernia surgery, which is rich in protein, fiber, vitamins, and minerals to support the healing process. It’s also important to avoid foods that can cause gas or bloating. Also, don’t forget to drink plenty of water throughout the day. It will help to flush out toxins from the body.
• In the long term, the patient will be advised to maintain a stable and healthy weight, as being overweight can increase the risk of developing hernias.
• Avoid straining during bowel movements as it can strain the abdominal area and increase the risk of damaging the repaired hernia. Try to relax or ask the surgeon to prescribe laxatives or stool softeners for easy bowel movements.
• Quit smoking for at least 4 to 6 weeks of recovery, as smoking can impair the healing process by making the blood vessels weak. It can also affect the body’s immune system negatively.
• After the recovery is complete, consult the Surgeon and include muscle strengthening exercises in the routine to improve overall health and prevent hernia recurrence.
• The patient needs to attend all scheduled follow-up consultations with the Surgeon to ensure proper healing, adjust medications, and address other concerns.

One thing to remember is that the recovery will be different for each patient. Therefore, it’ll be best to take personalized recommendations from the Surgeon for optimal healing.

Laparoscopic Hernia Surgery Cost in India

Laparoscopic Hernia Surgery Cost vary for each patient primarily due to the technique used.

The Laparoscopic Hernia Surgery Cost is calculated after accounting for the following factors:

• The type of hernia and its complexity/severity.
• The surgeon’s consultation and operating fee.
• The type or technique used for hernia repair (open, laparoscopic, or robotic).
• The choice of hospital, government or private, superspecialty or multispecialty.
• The city or location where the patient is getting Laparoscopic hernia surgery.
• Hernia mesh price (depending on the type of mesh used).
• Pre-operative diagnostic tests and evaluations.
• Hospitalization expenses, including room rent, amenities, admission, discharge, etc.
• Pre and post-operative care and medications.
• Complications, such as strangulation or incarceration, if any.
• Post-surgery follow-up consultations.

All these factors have a considerable impact on Laparoscopic Hernia Surgery Cost. Therefore, the patient needs to have a better understanding of these factors and consult a specialist to get an estimate for Laparoscopic Hernia Surgery Cost.

Is Hernia Surgery Covered Under Insurance?

Hernia surgery is covered under insurance, but the coverage can vary depending on the type of insurance plan owned by the patient and the specific terms and conditions outlined in the policy.

Though Laparoscopic hernia surgery is medically necessary, the insurance plans usually state the following regarding coverage-

• If the hernia is not causing any problematic symptoms and the patient is opting for surgery, the Laparoscopic hernia surgery will be considered an elective cosmetic procedure. Due to this, the insurance company will not provide coverage for asymptomatic hernias.
• If the hernia is symptomatic and causing difficulty in regular life, the insurance company will cover the cost of Laparoscopic hernia surgery entirely or partly as specified by the policy. In symptomatic cases, the patient also needs to provide clinical evidence clearly stating the symptoms experienced by the patient and demonstrating since when the problem has been evident. Once these documents are submitted, the insurance company will provide authorization to claim the insurance through cashless (in network hospitals) or reimbursement (in non-network hospitals).

It’s important that the patient talks to the health insurance agent to clearly understand the specified terms and conditions to find out if the policy has clauses like deductibles, co-payment, etc., and what amount of the sum insured can be claimed for hernia surgery. Clearly understanding the coverage will help the patient to make a well-informed decision.

Non-Surgical Hernia Treatment Options

Non-surgical methods to treat hernias primarily focus on managing the symptoms and reducing the discomfort. However, it should be noted that these management options cannot repair the hernia and surgery is the only effective treatment method for hernia repair.

Some general non-surgical options may include the following:

• Watchful Waiting: It is the initial approach for hernia management, especially in elderly and frail patients. This approach involves regular monitoring of the symptoms to ensure the hernia doesn’t become larger or more problematic.
• Dietary Modifications: Certain dietary changes can be very helpful in managing the symptoms associated with hernias, particularly hiatal hernias. These modifications include avoiding large meals, spicy foods, acidic foods, and carbonated beverages.
• Medications: Several over-the-counter and prescription medications can help to alleviate the symptoms of hernias. Such medicines include antacids, proton pump inhibitors, H2 blockers, etc.
• Support Garments or Hernia Truss: In asymptomatic cases, the patients may be advised to use a hernia truss or support garment to keep the organ in place. However, it is only a temporary solution and doesn’t treat the underlying condition.
• Physical Therapy: In certain cases, physical therapy might be recommended to promote self-healing of the abdominal muscles to reduce herniation and provide relief. However, the effectiveness of this method is unproven.

It should be noted that these non-surgical methods are not a substitute for surgery, and they may not help prevent the progression of the hernia. Therefore, it’ll be best to consult an expert and determine whether surgical intervention is necessary.

Hernia References & Guidelines

1. Dual docking technique for robotic repair of simultaneous inguinal and umbilical hernia
2. Robotic surgery for inguinal and ventral hernia repair

Hernia ICD 10