Child Learning Centre

Laparoscopy surgery is a very vital component of the hernia repair. Studies have shown that many patients have a better outcome when they opt for laparoscopic surgery. Candidates eligible for this mode of surgery include those with bilateral inguinal hernias, ventral hernias, and recurrent hernia. People associated with athletics and other outdoor sports prefer to go for a laparoscopic hernia surgery as it ensures a speedy recovery and minimal tissue invasion (due to small incisions).

Laparoscopic hernia repair- inguinal
A laparoscopic surgery requires an incision of 1-2 cm at the belly (at the lower end). Two small punctures are done near the umbilicus. The punctures are done to make room for the cameras so that the surgeon is able to view the abdomen clearly. The smaller incisions allows the operating instrument to enter into the stomach.

The Procedure:
A balloon is placed in between the abdomen and the overlying muscle so that the peritoneum can be separated. When space is successfully made, the camera comes into the action to view the condition of a hernia. A hernia is pulled from its hole into the abdomen. Once the hole is detected, the defect of a hernia is fixed.

Laparoscopic hernia repair- incisional/ventral: Laparoscopic hernia repair is suitable for all types of a hernia such as an umbilical hernia, ventral hernia, recurrent umbilical hernia, epigastric hernia etc. Just like an inguinal hernia, A camera is placed into the abdomen through the muscles. Two small incisions are made for the operating instruments to get through. This is followed by the cutting of the tissue that is placed between a hernia and the intestine. The hole thus gets exposed. Through one of the laparoscopic ports, the hernia mesh gets rolled and is placed into the abdomen. A hernia is then pulled up and the mesh gets secured with 4 sutures. A special device is used to fix the healthy muscle.

Tension free repair: “Tension free” repair is often used to symbolize hernia surgery. A hernia is often triggered by the weakened muscles. Few surgeons endeavors to sew the muscle around the area of a hernia. Since the muscles surrounding the hernia are weak in the first place, they pull apart causing a recurrence of a hernia. To avoid this, most surgeons use a mesh to strengthen the cells around the hernia region. This procedure ensures that the muscles aren’t sewn but the mesh placed over the hole can prevent the muscle to push through the walls of the abdomen.

The use of mesh: There are some reservations about using the mesh in a hernia surgery. However, this is the safest and most appropriate way to perform a hernia laparoscopic surgery. The use of a mesh also negates the risk of open incisions and recurrence of a hernia.

What is wound healing?
Wound healing is a process in which the body repairs itself after an injury by the complex mechanism by replacing destroyed tissues. It includes three types of intentions, and they are as follows:

1. Healing by primary intention
It includes healing in which restoration of continuity occurs by fibrous adhesion. Formation of granulation tissue does not take place and results in a thin scar.

2. Healing by secondary intention
In this type, healing takes place by adhesion of granulating surfaces. It occurs when the edges of the wound are far apart, and cannot be brought together.

3. Healing by tertiary intention
It is a combination of primary and secondary intention healing. In this type, the gradual filling of a wound cavity occurs by granulations, and by cicatrix formation. In this process various growth factors are involved, such as epidermal growth factor, vasculo-endothelial growth factor, platelet-derived growth factor.

How wound healing occurs?
Wound healing is divided into following phases:

1. Establishment of rapid homeostasis: In this phase, the actual bleeding stops. It is accomplished by vasoconstriction, in which blood vessels contract to stop bleeding.
2. Stage of inflammation: During this phase neutrophils (white blood cells) proliferates at the site of a wound to destroy bacteria, and to remove debris. The neutrophils are at highest count between 24, and 48 hours after an injury, and get reduced after 3 days. After that specialized cells called macrophage arrives to continue the process. These cells secrete growth factors and proteins that facilitate tissue repair. This phase lasts for 4 to 6 days and shows symptoms of edema, redness, heat, and pain.
3. Proliferation and migration of the cells: During the process of inflammation, the body releases cell which causes migration, and proliferation. In this phase, epithelial cells proliferate to overlap the wound, and this phase can last from 4 days to 24 days.
4. Formation of blood vessel: It is also known as angiogenesis. In this process body’s cells begin to replace the veins, and arteries which are damaged. In this process, the body either creates new vessels or adds onto the existing vessels. Along with this collagen deposition, granulation formation also occurs.
5. Stage of reepithelialization: Once the blood vessels are formed, the damage tissues also start regrowing.
6. Stage of synthesis: It is the last step, or it can occur simultaneously with above stages. In this process, blood clots are formed, which helps in prevention of further bleeding.

What are the complications of wound healing?
Most common complications are as follows:

1. Deficient scar formation
2. Excessive scar formation, such as a hypertrophic scar, keloids, etc.
3. Deficient contraction of wound or excessive contraction
4. Infection