Our Summary

This research paper is about the occurrence of internal hernias after a specific type of surgery called laparoscopic colorectal surgery. The researchers wanted to know how often this complication happened, what factors increased the risk, and how it can be managed.

They searched two large databases of medical articles and picked out 176 relevant ones. After more careful selection, they ended up with 15 articles that provided the most useful information.

Their findings were that internal hernias don’t happen very often after this kind of surgery - only about 0.65% of the time. They found 31 cases in total, most of which were associated with a specific type of surgery called a restorative left-sided resection. Almost all of these hernias happened within 4 months of the original surgery.

All of the patients with hernias needed another operation to fix the problem. More than a third of the patients also needed to have part of their bowel removed. In about half of the cases, the surgeons closed up the area that had allowed the hernia to happen (the mesenteric defect) during the second operation, and they were able to do this with laparoscopic techniques in about half of the cases. There were three deaths.

The researchers concluded that while internal hernias are a rare complication, they are important. They suggest that for patients who are at high risk, surgeons might consider closing the mesenteric defect during the initial surgery if they are having a left-sided restorative resection.

FAQs

  1. How often do internal hernias occur after laparoscopic colorectal surgery?
  2. What factors increase the risk of internal hernias after this type of surgery?
  3. What are the researchers’ suggestions for managing the risk of internal hernias in high-risk patients?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about colorectal surgery is to follow all post-operative care instructions carefully, including taking prescribed medications, eating a healthy diet, and avoiding strenuous activities. It’s also important to attend all follow-up appointments with your healthcare provider to ensure proper healing and to address any concerns promptly.

Suitable For

Patients who are typically recommended colorectal surgery include those with colorectal cancer, inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), diverticulitis, colorectal polyps, and other conditions that affect the colon and rectum. Patients who have not responded to non-surgical treatments or who are at high risk of complications may also be recommended for colorectal surgery.

Timeline

Before colorectal surgery:

  • Patient meets with their healthcare provider to discuss the need for surgery and potential risks and benefits
  • Patient undergoes pre-operative testing and preparation, which may include blood work, imaging scans, and bowel preparation
  • Patient may meet with a nutritionist or physical therapist to optimize their health before surgery
  • Patient is instructed on post-operative care and recovery expectations

After colorectal surgery:

  • Patient is monitored closely in the hospital for signs of complications, such as infection or bleeding
  • Patient may experience pain, fatigue, and changes in bowel habits as they recover
  • Patient gradually resumes normal activities and follows a diet plan recommended by their healthcare provider
  • Patient may need to attend follow-up appointments to monitor their progress and address any concerns or complications
  • Patient may need physical therapy or other rehabilitation services to regain strength and function in the affected area

Overall, the timeline of a patient’s experience before and after colorectal surgery involves thorough preparation, close monitoring for complications, and gradual recovery and rehabilitation to regain their health and quality of life.

What to Ask Your Doctor

  1. What is the likelihood of experiencing an internal hernia after laparoscopic colorectal surgery?
  2. Are there any specific factors that may increase my risk of developing an internal hernia?
  3. How soon after surgery might an internal hernia occur?
  4. What symptoms should I be aware of that may indicate the presence of an internal hernia?
  5. How is an internal hernia typically diagnosed?
  6. What treatment options are available if an internal hernia is detected?
  7. Will I require additional surgery if an internal hernia is found?
  8. What are the potential complications associated with internal hernias after colorectal surgery?
  9. Are there any preventive measures that can be taken to reduce the risk of developing an internal hernia?
  10. How experienced is the surgical team in managing and treating internal hernias following colorectal surgery?

Reference

Authors: Toh JW, Lim R, Keshava A, Rickard MJ. Journal: Colorectal Dis. 2016 Dec;18(12):1133-1141. doi: 10.1111/codi.13464. PMID: 27440227