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HERNIORRHAPHY

A herniorrhaphy is a surgical procedure used to treat medical problems stemming from a hernia condition. It is a specific surgical strategy where the hernia is repaired through a series of incisions and sutures. Herniorrhaphy is a medical term that combines the Ancient Greek words hernia and raphere, the latter meaning to suture or to make a seam. A herniorrhaphy procedure may also be known as hernioplasty or hernia repair, although hernioplasty denotes the use of a material foreign to the patient's body to help treat the hernia. Hernia refers to any protrusion of tissues or internal organs through an area of muscle in the body. Most often, a hernia can be found in the areas of the stomach or abdomen. It is a highly common medical problem that may be the result of genetic disposition or of strenuous activities such as heavy lifting. People that are bothered by a hernia may opt for surgery. Hernias, however, can become dangerous when the protrusion is such that the blood supply to the hernia is cut off. This can lead to tissue death. In this case, the hernia becomes a medical emergency and usually requires an emergency surgical intervention. Herniorrhaphy is a specific treatment employed relative to the type of hernia problem that the patient is experiencing. There are two possible herniorrhaphy procedures: traditional and laparoscopic. In the former, an incision is made through the skin covering the hernia and the protruding tissues are forced back into place. The doctor then sutures the tear. A laparoscopic herniorrhaphy utilizes a laproscopic device to help in the procedure. The laporscopic device is a miniature telescope that has a tiny camera fastened to it, enabling the doctor to see the hernia on a monitor. Using longer surgical instruments, the doctor can fix the hernia from behind the abdomen wall. In the cases where herniorrhaphy is used as a surgical procedure, the success rates typically are very high. Generally, there is only a 1.6 percent chance of the hernia reoccurring. The successes in herniorrhaphy surgery have made the procedure relatively simple in the United States, which means that the patient may return home from the hospital on the same day of the operation. A herniorrhaphy procedure normally requires only the employment of a local anesthetic by the medical staff. Ventral hernia is a tissue defect that develops at a location where a surgical incision has been previously made. In a ventral hernia repair procedure, this surgical hernia is repaired, and the weakened tissue is strengthened with surgical techniques. Ventral hernia repair is also known as incision hernia repair, because the hernia develops at the site of a previous surgical incision. Ventral hernia typically develops in the wall of the abdomen but also can occur in the groin or any location where a surgical incision is present. At the site of a previous surgical incision, muscles tend to be weaker than normal, and this weakness can lead to a tear or bulge in the muscle. When this occurs, part of an organ, such as the intestine or bowel, can protrude through the tear in the muscle. This protrusion is called a hernia. The most common symptom of a ventral hernia is the characteristic bulge in the abdomen, caused by the protrusion of tissue through the tear in the muscle wall. Not all ventral hernias cause pain, but even if no pain is present, the site might be tender and uncomfortable when pressure is exerted. Physical strain such as coughing, lifting and bowel movements can be sources of pressure and can cause pain at the hernia site. Even if no pain is present, ventral hernia repair still is a necessary procedure to prevent the hernia from worsening. Ventral hernia repair can be carried out using open surgery or laparoscopic surgery. In open surgery, a large incision is made in the abdomen, through which the surgeon repairs the hernia by pushing the dislocated tissue back into place. Next, he or she strengthens the muscle wall by trimming excess tissue and stitching the muscle tear closed. The surgeon might also use synthetic mesh supports to strengthen the muscles. Laparoscopic surgery includes similar steps to repair the hernia but is carried out very differently. In this type of surgery, several very small incisions are made in the abdomen, instead of one large incision. Laparoscopic instruments, a light source and a tiny video camera are inserted through these incisions. The camera transmits images to an overhead screen that provides the surgeon with a view of the interior of the abdomen. Recovery time after ventral hernia repair is much faster when the surgery is carried out laparoscopically. In most cases, a patient can leave the hospital within 24 hours after undergoing laparoscopic surgery, whereas a stay of several days might be needed after open surgery. Additional advantages of laparoscopic surgery are that most patients recover more quickly,

have less pain and can return to normal levels of activity much sooner. When the procedure is performed by an experienced surgeon, a relapse of the hernia is much less likely to occur after laparoscopic surgery. Open Inguinal Hernia Repair (Herniorrhaphy, Hernioplasty) For open hernia repair surgery, a single long incision is made in the groin. If the hernia is bulging out of the abdominal wall (a direct hernia), the bulge is pushed back into place. If the hernia is going down the inguinal canal (indirect), the hernia sac is either pushed back or tied off and removed. The weak spot in the muscle wall-where the hernia bulges through-traditionally has been repaired by sewing the edges of healthy muscle tissue together (herniorrhaphy). This is appropriate for smaller hernias that have been present since birth (indirect hernias) and for healthy tissues, where it is possible to use stitches without adding stress on the tissue. But the surgical approach varies depending on the area of muscle wall to be repaired and the surgeon's preference. What to Expect After Surgery Most people who have open hernia repair surgery are able to go home the same day. Recovery time is about 3 weeks. You most likely can return to light activity after 3 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Why It Is Done Surgical repair is recommended for inguinal hernias that are causing pain or other symptoms and for hernias that are incarcerated or strangulated. Surgery is always recommended for inguinal hernias in children. Infants and children usually have open surgery to repair an inguinal hernia.