Laparoscopy offers a very effective and less invasive alternative to the traditional type of inguinal hernia repair. For a traditional repair, an incision is made in the groin, the hernia sac is removed or reduced (pushed back in), and the defect is repaired either with sutures or with mesh. Healing generally takes 2 to 6 weeks depending of the extent of the hernia and the type of repair. The laparoscopic repair also removes or reduces (pulled back in) the hernia sack and then places the mesh behind the abdominal wall muscles rather than on top of them as with the open repair. This allows the abdominal cavity to seal the mesh against the abdominal wall and allows for an almost immediate ability to perform full activities with no mandatory waiting period. The laparoscopic incisions are smaller and tend to cause less pain which also facilitates a quicker recovery. This is an excellent choice for persons who need a rapid return to work or to strenuous physical activity. It is also a good option for the repair of recurrent and bilateral (both sides) hernias. In the case of a recurrent hernia, the laparoscopic repair avoids the scar tissue from the previous operation(s) which can be problematic both in identifying the important structures and in finding good tissue to use for the hernia repair. In persons with bilateral hernias, laparoscopic repair of both sides can be performed at one setting utilizing the same three small incisions and generally adds very little additional time to the procedure. The incidence of complications following laparoscopic hernia repair is similar to that of the traditional open repair, and as experience grows, actually may be less, including a very low rate of recurrence.
A surprisingly large number of people suffer from heartburn, or gastroesophageal reflux disease (GERD), many of them on a daily basis. There are many excellent medications available to treat the symptoms of heartburn and for most people this is sufficient. For some, however, medical treatment is either ineffective or incompatible with their lifestyle. For those who have persistent or recurrent symptoms despite medical therapy, or for those who don’t wish to be reliant on medications for the rest of their life, laparoscopic antireflux surgery provides an excellent option. There is also an increasing concern over the rising incidence of esophageal cancer which has been linked to chronic GERD through changes in the lining of the esophagus, called Barrett’s esophagus. A national registry has been formed to study the question of whether surgery will prevent the formation of Barrett’s esophagus, prevent the progression of Barrett’s esophagus into cancer, or cause the regression of Barrett’s esophagus back to normal. Laparoscopic Nissen fundoplication is the standard procedure performed for GERD and, in contrast to medical therapy, it provides a cure for the reflux not just control of the symptoms. In brief, it is a minimally invasive operation which typically involves the repair of a hiatal hernia (a condition where the stomach pushes up through the diaphragm and which is often found in persons with GERD) combined with wrapping the upper part of the stomach around the lower part of the esophagus. This latter part essentially recreates the natural anatomic barrier (the lower esophageal sphincter) which helps prevent the reflux of stomach acid into the esophagus. Five small incisions are required (from 1/4 to 1/2 inch in length) to perform this procedure and the hospital stay is generally one to two days. Full recovery may be as short as two weeks, long-term sequelae are minimal and successful cure of heartburn is around 90%.
This is a rare but serious condition in which the stomach (and occasionally other abdominal organs) pushes up, or herniates, through an abnormally enlarged opening in the diaphragm into the chest cavity. This is considered a type of hiatal hernia, but it is one that can cause far more serious symptoms and consequences than those of the common hiatal hernia which is generally associated only with heartburn. The symptoms of a paraesophageal hernia can range from trouble swallowing to severe chest pain following a meal. Regurgitation of food, heartburn, chronic blood loss and even strangulation of the stomach can occur. The traditional operation involves either a long incision through the chest or one through the abdomen or sometimes both. Usually, persons with this problem are elderly and have a variety of medical problems making major surgery risky. Laparoscopic repair of paraesophageal herniae is a minimally invasive procedure and offers a lower incidence of complications, a shorter hospital stay, and a quicker and less painful recovery. The repair involves pulling the stomach back down into the abdomen, removing the hernia sac, narrowing the opening in the diaphragm and usually fixing the stomach to the diaphragm.
There are a variety of diseases that affect the spleen and can cause destruction of blood cells, platelets or red cells. ITP, or immune thrombocytopenic purpera, is a disease which destroys platelets and can lead to bleeding problems. If not controlled by medication, splenectomy is highly effective at curing this disease. Hereditary spherocytosis destroys red blood cells and also responds well to splenectomy. A variety of other disorders of the spleen can respond or require splenectomy. Laparoscopy is ideally suited to this operation especially if the spleen is of normal or reduced size although even enlarged spleens can be removed this way. The recovery is quicker and easier than with open surgery and generally involves minimal blood loss and low complication rates.
Diseases of the adrenal gland are fairly rare but can lead to very significant illnesses, including cancer. Laparoscopic removal of the adrenal gland can be done effectively and safely through several small incisions. Conversely, the open operation either involves a long abdominal incision or one through the back or flank, including the removal of a rib. It has become the gold standard operation for adrenal tumors in many institutions world wide.
Laparoscopic colon resection is an option to conventional open surgery. It is ideal for benign diseases such as colon polyps, diverticulitis, inflammatory bowel disease, and lower gastointestinal bleeding. It offers a shorter hospital stay, shorter convalescence, less pain, and better cosmesis. It also results in fewer adhesions and consequently may lower the subsequent risk of intestinal obstruction. Laparoscopic surgery for colon cancer is also performed widely, however the is still some controversy whether it is as effective and safe as open surgery. In expert hands, it appears to be so, and every year more data is collected to support this procedure.
This type of hernia involves a defect in the abdominal wall that may be congenital or acquired following a prior operation. The latter type is called an incisional hernia. These herniae can be fixed either with an open incision or with laparoscopy. Both types of repairs utilize mesh to cover or secure the defect to prevent recurrence of the hernia. Open surgery can be very painful requiring a hospital stay, may miss “occult” hernia defects that cannot be felt or seen from the outside, and has a higher complication rate, including infection and recurrence. Occult hernia defects may develop in time into larger defects that will require additional surgery. Laparoscopy offers a minimally invasive approach to the repair of these herniae. The hernia contents are separated from the defect in the abdominal wall and a large piece of mesh is secured across the defect. Occult defects can be visualized and repaired along with the primary hernia. Generally the laparoscopic repair is performed as an outpatient procedure but may require a brief overnight stay in persons with additional medical concerns.
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Laparscopic
Procedures
