What type of Anesthetic is used?A general anesthetic is used to allow complete relaxation of the abdominal muscles. This results in nausea for some patients as the main side effect. The anesthesiologist will discuss other risks with you at the time of the procedure.
What are the Potential Complications?As with any surgery we always worry about the risk of bleeding or infection where the surgery was performed (less than 1%). Additionally, with hernia surgery there is a risk of injury to the spermatic cord which carries the blood supply and sperm tube, which could result in sterility if injured on both sides or can cause changes in the testicles such as pain, swelling or shrinkage (less than 1%). The patch which is placed is artificial and can become infected requiring treatment with antibiotics or even removal. There is an approximately 1% recurrence rate in the immediate postoperative period with the 5 year results about 2%.
Open RepairWith the open or traditional approach an incision is made in the groin over the site of the bulge. The muscle layers are divided to reach the neck of the hernia which is then reduced into the abdomen. The muscle layers are then reap–proximated and a patch material is placed over the repair to help prevent a recurrence.
Pro's include known long term results with a recurrence rate approximately 2–5% may be performed with a local, spinal or general anesthetic. Con's include increased discomfort in immediate postoperative period Time off of work approximately 2–4 weeks.
Where do you get Hernias?The groin area is the most common site of a hernia (80%), hernias in this area are called inguinal hernias. But hernias can occur below the groin area (femoral), at the belly button (umbilical), in the abdominal area and at sites of prior surgery (incisional).
Why do people get hernias?Men, women, and children of any age can get hernias. They can occur because you were born with a natural weakness in the abdominal wall, or from a weakness acquired with age. Contributing factors include previous surgery in the abdominal area, excessive weight gain, pregnancy, constipation, infection, malignancy, or trauma. Strenuous physical activity including heavy lifting may also be a contributing factor.
How are hernias treated?Hernias don’t go away. All defects, even ones that show no symptoms (“Asymptomatic”), should be surgically corrected since the risks of surgery are much less than the risks to you of not fixing the hernia. Once you develop symptoms, surgical repair is mandatory. Small asymptomatic hernias can sometimes be pushed back into place by your doctor, but surgery is the only way to really fix a hernia.
Surgical repair of hernias
There are two main ways to surgically fix a hernia: open repair and minimally invasive laparoscopic repair.
Open Surgical Repair of Hernia
This type of repair involves making a cut (incision) over the hernia, carefully dissecting through the body tissues and closing the area of weakness. Usually a mesh (composed of gortex, teflon or other material) is sewn into place over or under the weakened area to make it stronger and to prevent recurrence. After the repair, the incision is closed and covered with bandages and tape.
Local anesthesia (lidocaine, mepivacaine) is commonly used to prevent you from feeling pain during the procedure. In addition, the anesthesiologist gives a mixture of short–acting sedating medications to provide comfort. Occasionally spinal or general anesthesia may be required for larger hernias or more complicated cases. Postoperative pain may be managed with a combination of intravenous, intramuscular and oral painkillers. You may have some trouble urinating for the first 12–24 hours following the procedure.
The main disadvantage of the open technique is that it can cause considerable pain. You may not be able to return to work for a week or longer and full activity may not be possible for up to six weeks. Swelling and black and blue discoloration of the wound site is common. Repairs of repeat inguinal hernias, and two sided repairs, are much more painful and have a much longer recovery period.
By far the commonest replacement joint is made from Silicone rubber and was designed by Dr. Al Swanson from Grand Rapids Michigan. It is beautifully simple, acting as a flexible hinge. Because of its structure it does not accurately replicate the biomechanics of the joint it replaces, and so full function is never restored. In addition it is made of a friable material and for this reason it is subject to attritional wear. Most surgeons therefore use it almost exclusively in the low demand low load hands of rheumatoid patients where it can be very successful indeed.
In addition the joint has no inherent lateral stability, which is not a problem in the MCP because the adjacent joints bolster it, but in the PIP it can pose problems resisting lateral stress.
Many of us believe that the ideal range of motion after an MCP joint replacement is about 30 to 40 degrees, compared with 90 degrees in the unaffected hand. Many other designs have been tried and continue to be developed but none have achieved the wide acceptance of the Swanson Implant. Ligaments and Tendons in Rheumatoid Arthritis