DIAGNOSIS

It is performed by physical examination. Only in difficult cases can imaging studies, such as ultrasound or computed tomography, play a role in the diagnosis. Occasionally, laparoscopy can be diagnostic and therapeutic for particularly difficult cases.

TREATMENT / INDICATIONS

As mentioned above, a hernia can be repaired by approximating the patient’s own tissues or using a prosthetic material to close the defect, the former has been largely abandoned (it is reserved for specific cases) and the latter technique, the «tension free» repair is now the standard. Tension-free repair can be performed through the traditional, «open or anterior» approach or the «laparoscopic approach»; Dr. Rosales’ preference is to use the latter method in most of his patients, considering the great advantages offered by laparoscopy.

INDICATIONS FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

• Direct and indirect inguinal hernias
• • Femoral hernias
  • Bilateral hernias
  • Recurrent hernias

CONTRAINDICATIONS

• Inability to use general anesthesia.
• Inability to «shrink» hernia contents prior to surgery or after induction of anesthesia.
• High risk of bleeding

COMPLICATIONS

• Sangrado <1%
• Hematoma 5%.
• Lesión visceral <1%
• Wound infection 2%.
• Obstrucción intestinal <0,5%
• Urinary retention 2%.
• Nausea and vomiting 8%.
• Recurrence 1 – 3%.
• Inguinodynia (chronic groin pain) 1%.

** These complications are low in frequency in experienced hands, some of them are related to the patient and to any other laparoscopic procedure, so it is even lower if the surgeon is trained in advanced laparoscopic procedures. In addition, it should be remembered that many of these complications are transient and can be easily addressed.

«Example of forces exerted from inside a tire; the same is true of the abdominal wall, so laparoscopic placement of the mesh (i.e., fixed from the inside) takes advantage of the natural forces of the abdominal wall to keep the defect completely covered and the mesh in place.»

Advantages of laparoscopic versus open inguinal hernia repair

• Very small incisions (3)
• Ability to use the natural forces of the abdominal wall to anchor the mesh in place.
• Better visualization of the anatomy of both groin regions, as there is a possibility of bilateral defects.
• Rapid recovery time (one night hospitalization)
• Minimal postoperative pain.
• Lower morbidity rate
• Shorter hospital stay
• Return to normal activity and work in a shorter period of time (complete recovery in 5 to 7 days).
• Decreased risk of wound infection and hernia formation.
• Minimal scarring

Under general anesthesia, a 10 mm incision is made in the umbilicus, CO2 is introduced into the cavity, then 2 more incisions are made in the abdomen (both 5 mm) to introduce the instruments, the hernia defect is detected, the hernia sac and its contents are returned to the abdominal cavity, the whole area is dissected and the mesh is introduced through one of the incisions and placed in the groin region, then stapled, the incisions are closed with sutures and the procedure is completed.

** The materials Dr. Rosales uses depend on what is best for your case and your personal preference.

FEMORAL HERNIAS
Since this type of hernia is also considered an inguinal hernia, and since it is diagnosed and treated with exactly the same techniques as inguinal hernias, it is not necessary to highlight the details of it.