Hernias will not resolve by themselves and may cause greater problems if they are left untreated. There are a variety of surgical treatment options which your general surgeon will discuss with you. This article discusses the types of hernia and examines the surgical options available.
What is the difference between TEP and TAPP surgeries?
A hernia occurs when an organ pushes through the structural weakness of its surrounding muscular or tissue wall. This is characterised by a noticeable bulge or lump under the skin, usually in the abdominal region. Inguinal hernias, which are in the groin area, account for about 75 percent of abdominal hernias – for which men are particularly susceptible.
Without proper treatment (surgical repair), a hernia could enlarge and cause intermittent discomfort or pain to the patient. While this has obvious impact on the quality of life, other serious complications may arise if the hernia is left untreated and enlarges over time. These include intestinal obstruction which may further lead on to strangulation and death of the intestine. When this happens, severe sepsis sets in, and the health consequences are dire.Some hernias such as an inguinal (indirect) hernia can protrude into a male patient’s scrotum causing significant pain and swelling in the testis.
Firstly, what types of hernia are there?
A hernia is classified by its anatomical location. Inguinal hernias are the most common and is the focus of this article. Nevertheless, there are several common types of hernias worth knowing:
- Inguinal hernias: commonly occurs at weaknesses above the inguinal ligament, located above the groin. Affects men and women alike.
- Femoral hernias: occurs in the upper section of the thigh, below the inguinal ligament. Mostly affects women.
- Incisional hernias: post-surgical scars may form particular weak spot where hernias arise. Anyone with previous abdominal surgery is at risk, especially overweight adults.
- Umbilical hernias: located at weaknesses in the abdominal wall in proximity to the navel area (belly button). Affects babies and may persist into adulthood.
- Epigastric hernias: occurs through gaps in the abdominal wall between the breastbone and the belly button.
Source: Institute for Quality and Efficiency in Health Care
Hence, it is important to look for symptoms and identify surgical options for hernias when they occur, as recommended by your doctors.
What are the symptoms to look out for?
The most common symptom is pain in the abdominal area where the hernia has occurred. This can be accompanied by apparent bulges in the affected area, formed by the hernia sac. In most cases, a dull pressure or pulling sensation is felt. This is especially noticeable when the patient is engaging in strenuous physical activities such as lifting heavy objects, running, and jumping. Chronic cough and static strainingmay also bring about these symptoms. The symptoms typically disappears when one is in a lying position. This is because the herniated organ falls back into the abdominal cavity under gravity.
However, some patients may not experience these symptoms especially in the early stages of a hernia formation. These patients may only experience pain when straining and tensing their abdominal muscles.
When these symptoms are present, seek a consultation and examination by your doctor. The diagnosis is often confirmed by a simple ultrasound or CT scan.
Left untreated, these hernias could induce severe pain, nausea and even vomiting. This could be an indication that a loop of intestine has become blocked or cut off. Now, this is an immediate warning sign that urgent treatment is needed as it could rapidly lead to bowel ischaemia, gangrene or perforation and infection (peritonitis).
Surgery is the only treatment for hernias and entails pushingthe hernia sac (with its contents)back into the abdomen or removing it entirely. This is followed by placing a mesh implant which prevents the hernia sac from protruding out again. Your surgeon will advise on the timing and type of surgery required, as the risks may be higher for certain patients. Read on to learn more about the available laparoscopic surgery (minimally invasive surgery) options that are employed in treating inguinal hernias.
Total Extraperitoneal (TEP) Repair Surgery
One approach to laparoscopic surgery for hernias is total extraperitoneal (TEP) repair. TEP hernia repair, importantly, avoids potential complications associated with intra-abdominal access during surgeries. This is owing to the depth in which the surgical instruments are inserted and where the actual operation takes place.
During TEP, surgeons access the extraperitoneal cavity after creating apreperitoneal space with a dissecting balloon, or blunt dissection using a laparoscope. Although there are many technical variations to how this surgery is performed, the key is that TEP surgeries are generally safe and effective with minimal chances of recurrence.
Although TEP avoids the need to enter the abdominal cavity, it does present other risks and complications. Some of the serious complications involve injuries to vascular and nerve structures and bladder – particularly if the surgeon fails to recognise a distorted anatomy. These complications are, nonetheless, rare at about ~0.5% occurrence. The expertise and experience of the general surgeon is thus very important.
Transabdominal Preperitoneal (TAPP) Repair Surgery
Similarly, an alternative laparoscopic approach is the transabdominal preperitoeal (TAPP) repair. This minimally invasive approach also offers patients a faster recovery with less pain and muscle damage compared to open surgery options.
In the case of TAPP, the surgeon inserts surgical instruments into the abdomen or peritoneal cavity. Although TAPP is technically easier because of a larger surgical working space, there is a risk of visceral injury to bowel and vascular structures. In some patients, this approach is more challenging especially if they have had a previous abdominal or pelvic surgery which leads to internal scar-formation.
What is the recovery process post-surgery?
Laparoscopic surgery approaches such as TEP or TAPP generally require a general anaesthesia. The advantage of laparoscopic surgery is less post-surgical pain and smaller scars. Patients can expect to be discharged the next day or within the same day after a period of observation (same-day surgery). Within a week, patients should be able to resume normal activities, though strenuous activities should still be avoided or minimised.
In summary, both TEP and TAPP approaches offer promising alternatives to open surgery, causing less pain and shorter recovery times. Consult our experienced general surgeon at Thomas Ho Surgery to understand which approach is suited for your hernia condition.
