Our Summary

This research paper focuses on a medical condition known as contralateral inguinal hernias, which are hidden hernias on the opposite side of the body that are often discovered during a hernia repair surgery. The study aimed to determine whether it is safe and effective to repair these hidden hernias if they are found during a routine hernia repair.

The research team looked at 13 previous studies involving 5000 patients. They found that nearly 15% of patients had these hidden hernias. Among the patients who had the hidden hernias repaired during their initial surgery, about 10% experienced complications after surgery. However, among the patients who did not have the hidden hernias repaired (expectant management), about 29% needed surgery later to repair the hernia because it started to cause symptoms.

Using a decision-making model, the team calculated that if 1000 patients were to have hernia repair surgery, about 150 would be found to have a hidden hernia. If these were repaired, around 15 patients would experience post-surgery complications and about 105 would undergo unnecessary repair. If the hidden hernias were not repaired, about 45 patients would require another surgery later to fix the hernia.

The study concluded that it is not necessary to repair hidden hernias found during hernia repair surgery. However, they also noted that most of the evidence for this conclusion comes from observational studies, which can be highly biased.

FAQs

  1. What are contralateral inguinal hernias and how common are they among patients undergoing hernia repair surgery?
  2. What is the risk of complications if hidden hernias are repaired during the initial hernia repair surgery?
  3. Does the study suggest that hidden hernias found during hernia repair surgery should be repaired immediately or managed expectantly?

Doctor’s Tip

A helpful tip a doctor might give a patient about laparoscopic hernia repair is to discuss with them the possibility of hidden hernias on the opposite side of the body that may be discovered during the surgery. It is important for the patient to understand the risks and benefits of repairing these hidden hernias during the initial surgery versus opting for expectant management and potentially needing another surgery later. Ultimately, the decision should be based on the individual patient’s situation and preferences.

Suitable For

In general, patients who are recommended for laparoscopic hernia repair are those with inguinal hernias, which are the most common type of hernia. Laparoscopic hernia repair is typically recommended for patients who have smaller hernias, are younger and healthier, and have a lower risk of complications. These patients may also have a higher likelihood of a faster recovery time and less post-operative pain compared to traditional open hernia repair surgery.

Patients with recurrent hernias, bilateral hernias (hernias on both sides of the body), or hernias that have become incarcerated or strangulated may also be recommended for laparoscopic hernia repair. Additionally, patients who are at a higher risk for surgical complications, such as those with obesity, diabetes, or other medical conditions, may also benefit from laparoscopic hernia repair due to its minimally invasive nature.

Ultimately, the decision to undergo laparoscopic hernia repair should be made on a case-by-case basis, taking into consideration the patient’s overall health, the size and location of the hernia, and any potential risks or complications associated with surgery. It is important for patients to discuss their options with their healthcare provider to determine the most appropriate treatment plan for their individual situation.

Timeline

Overall, the timeline for a patient before and after laparoscopic hernia repair surgery would typically involve the following steps:

Before surgery:

  1. Patient experiences symptoms of a hernia, such as a bulge or pain in the affected area.
  2. Patient consults with a doctor who confirms the presence of a hernia through physical examination and possibly imaging tests.
  3. Patient discusses treatment options with their doctor, including the option of laparoscopic hernia repair.
  4. Patient undergoes pre-surgical evaluations and preparations, including fasting before the surgery and possibly stopping certain medications.

During surgery:

  1. Patient is administered anesthesia and prepped for the laparoscopic hernia repair procedure.
  2. Surgeon makes small incisions in the abdomen and inserts a laparoscope to view the hernia.
  3. Hernia is repaired using mesh or sutures to strengthen the abdominal wall.
  4. Procedure typically takes around 1-2 hours.

After surgery:

  1. Patient is monitored in the recovery room before being discharged home.
  2. Patient may experience some pain, swelling, and bruising in the surgical area, which can be managed with pain medications.
  3. Patient is advised to avoid heavy lifting and strenuous activities for a few weeks to allow for proper healing.
  4. Follow-up appointments are scheduled to monitor the healing process and check for any complications.
  5. Patient gradually resumes normal activities and should experience relief from hernia symptoms.

In the case of contralateral inguinal hernias, if a hidden hernia is found during the initial surgery, the decision whether to repair it or not will depend on the patient’s individual circumstances and the risks and benefits of immediate repair versus expectant management. The study discussed above suggests that for most patients, it may be safe to leave hidden hernias unrepaired during the initial surgery and monitor them for symptoms later on.

What to Ask Your Doctor

  1. Should I be concerned about the possibility of having a hidden hernia on the opposite side of my body during the laparoscopic hernia repair surgery?
  2. What are the potential risks and benefits of repairing a hidden hernia if it is discovered during the surgery?
  3. How common is it to find hidden hernias during routine hernia repair surgeries?
  4. What are the potential complications that may arise from repairing a hidden hernia during the initial surgery?
  5. What are the risks associated with not repairing a hidden hernia if it is found during the surgery?
  6. How will you determine whether or not to repair a hidden hernia if it is discovered during my surgery?
  7. Are there any specific factors that would make it more likely for me to have a hidden hernia on the opposite side of my body?
  8. What is the likelihood that I may need another surgery to repair a hidden hernia if it is not addressed during the initial surgery?
  9. Can you explain the decision-making model that was used in the research study to determine the best course of action for hidden hernias found during hernia repair surgeries?
  10. Are there any alternative treatment options or approaches that I should consider regarding hidden hernias during my laparoscopic hernia repair surgery?

Reference

Authors: Dhanani NH, Olavarria OA, Wootton S, Petsalis M, Lyons NB, Ko TC, Kao LS, Liang MK. Journal: BJS Open. 2021 Mar 5;5(2):zraa020. doi: 10.1093/bjsopen/zraa020. PMID: 33688950