Complications of Hernia Surgery - A Brief Comprehensive

Introduction

Hernia occurs when the muscle is weakened, and the part of the organ which is contained by it is bulged out, which occurs due to heavy pressure in the abdomen, such as heavy lifting or straining for bowel movements. It causes pain and discomfort. Some hernias are present at birth and show up in a later stage. Treatment for these includes open surgical repair or using a laparoscopy.

What Is Hernia?

Hernia is a condition when a part of the organ is bulged out of its place because of weakened muscle and tissue which contains it.

What Are the Types of Hernia?

Common types of hernia are:

1. Inguinal hernias: The bulge occurs in the groin area when the intestine bulges through two inguinal canals. Men are more affected.

2. Femoral hernias: The bulge is in the upper thigh, below the groin, which occurs in the femoral canals. Women are more affected.

3. Ventral hernias include:

   1. Epigastric hernias: These occur in the upper part of the belly button.

   2. Incisional hernias: This occurs through the previous abdominal surgical scar.

   3. Umbilical hernias: These occur around the umbilical cord.

4. Hiatal hernias: The bulge occurs through the opening called a hiatus in the diaphragm, and a part of the upper stomach is pushed into the chest cavity.

What Are the Causes of Hernia?

The causes of hernia include:

• Familial history of hernia.

• Causing pressure in the belly due to heavy lifting or straining.

• Obese.

• Chronic constipation.

• Chronic coughing.

• Difficulty in urinating.

• Enlarged prostate.

• Peritoneal dialysis.

• Smoking.

• Undescended testicles.

• Ascites (a condition where there is fluid accumulation in the abdomen).

• Poor nutrition.

What Are the Symptoms of Hernia?

The symptoms of a hernia are:

• Noticeable bulge.

• Pain and discomfort near the area.

• Not able to pass gas.

• Symptoms worsen while lifting heavy objects, standing, or straining.

• Hiatal hernias may cause heartburn, regurgitation of food, and acid reflux.

• Strangulation of hernia occurs. When it gets stuck in the hole, it loses its blood supply, which causes severe pain and swelling.

• Nausea and vomiting.

What Is the Treatment of Surgical Hernias?

In a surgical procedure, the weakened abdominal muscle is repaired, and holes are closed. Most hernias require surgical treatment, which includes:

• Open Hernia Surgery: In this procedure, an incision is made near the hernia, and the weakened muscle is repaired. Surgical mesh can also be used to support weak muscles. When sutures are used without mesh, it is called primary closure, which is done in the case of small hernias, strangulated hernias, and inguinal hernias in the case of infants.

• Laparoscopic Hernia Surgery: Several small incisions are made instead of large incisions, which use a device that has a video camera and can be monitored on the screen. Advantages of laparoscopy include decreased scarring, excellent visualization, extended reach, and a faster healing rate.

What Are the Complications of Hernia Surgery?

Complications of hernia surgery during the intraoperative stage include:

• Wide linea alba may occur during the breaching of the peritoneum; in such cases, the incisions should be given more laterally to the rectus sheath (fibrous sheath that contains the abdominal muscles).

• Improper placement of balloon trochar (an instrument used during the laparoscopic surgery to dissect space in the peritoneum) may cause:

  1. Dissection of muscle fiber.

  2. Rupture of the balloon trochar.

  3. Punctured peritoneum.

  4. Bladder injury occurs due to improper trochar placement and operating in a filled bladder. It is diagnosed by the presence of urine in the extraperitoneal space. In such cases, the repair is done with vicryl, and a urinary catheter is placed for a week.

  5. Blood vessel injury is one of the common complications. Rectus muscle vessel, inferior epigastric vessel, venous plexus, aberrant obturator vein, testicular vessel, and iliac vessel injuries can occur. Immediate control of bleeding should be achieved by using clips or cautery.

• Pneumoperitoneum (presence of gas in the abdominal cavity) due to entering into the peritoneum (sheet covering the abdominal cavity and its organs).

• Improper identification of anatomical landmarks.

• Bowel injury results in the case of a large hernia and from opening the peritoneum inadvertently.

• Injury to the vas deferens (a tube that carries sperm out of the testes), while separating hernia from the cord structures, can cause fibrosis and narrowing of the tube, which occurs in case of inguinal hernia repair. In the case of young patients, a complete transection of the vas deferens should be done.

Complications of hernia surgery during the post-operative stage include:

• Hematoma (blood collection outside the blood vessels) is one of the most common complications in laparoscopic surgeries and large hernia repairs, which resolves after four to six weeks.

• Seroma (accumulation of fluid under the skin).

• Urinary retention is seen in elderly patients with prostatism (a condition that obstructs the bladder’s neck).

• Neuralgia (sharp pain due to nerve damage) occurs while using mesh intraperitoneally. Neuralgias occur due to fibrosis caused by the mesh. In the case of inguinal hernias, this is avoided by fixing the mesh laterally to the inguinal ring, safely dissecting the large hernial sac, and avoiding dissection of fascia on the psoas (a muscle located in the lateral lumbar region).

• In the case of inguinal surgical hernia repair, swelling and pain in the testicular region occur due to excessive dissection of the hernial sac from the cord.

• Orchitis (inflammation of testicles).

• Due to the mesh, complications such as infection of the mesh, pain, bowel obstruction, recurrence, and adhesion can occur.

• Wound infection.

• Recurrence of hernia can be avoided by using the proper surgical techniques.

Conclusion

Hernia is a painful disorder that needs surgical repair. Laparoscopic surgery has gained popularity for many surgeries, including hernia repair. Using mesh can be useful in hernia repair by decreasing recurrence and providing strength to the weak muscle. Complications after the surgery can include the occurrence of a wide linea alba, improper placement of balloon trochar, pneumoperitoneum, bowel injury, injury to the vas deferens, hematoma, seroma, wound infection, and recurrence of the hernia. Preventive measures include avoiding pressure on the belly, such as heavy lifting, straining, and chronic coughing or sneezing.