Inguinal & umbical hernia
Appendix
Gallstones
Diagnosis
The urologists need to make some assessments before performing URSL. These assessments are made through a couple of diagnostic tests, including Imaging tests (X-ray, Abdominal Ultrasound, MRI), Blood Urea Nitrogen (BUN) test, Bl
Similar to other surgical procedures, the following complications can arise during inguinal hernia surgery:
- Reaction to anesthesia
- Injury to the internal organs
- Excessive bleeding
- Infection
In addition, even after inguinal hernia surgery is complete, for a month or so until the recovery is complete, there are chances of post-surgery complications, such as-
- Mesh Infection
- Severe pain in the wound or stitches
- Seroma or fluid accumulation
- Hematoma or blood accumulation
- Wound infection
- Urinary retention
- Recurrence
To make sure that these complications don’t arise, the doctor gives a detailed recovery plan with clear instructions on the dos and don’ts after inguinal hernia repair surgery.
ood Test, and Urinalysis. The aim of carrying out these assessments is to figure out the size of the stone, the number of stones that need to be removed, and their location.
These tests also help doctors look for any underlying diseases that can cause complications in the procedure. The urologists will proceed with the procedure only after assessing the results of the tests carefully.
Procedure
This surgery is performed in the following steps:
- The patient is administered spinal or general anesthesia, depending upon the requirement.
- Then, the surgeon inserts a thin, long fiber-optic scope called a ureteroscope into the ureteral passage through the urethra. Simultaneously, the surgeon uses x-ray to see inside the kidneys and ureters and locate the stones exactly.
- Once the stone is located, it is collected in a stone basket and eventually pulled out of the system.
- If the stone is too large in size, then the surgeon uses a precision laser to break it into smaller pieces. The small stones can pass through the system naturally.
- The surgeon usually inserts ureteral stents to help flush out the stones from the body. The stent expands the passage of the ureter, which makes it easier for the stone fragments to travel through the ureter and out of the body.
The preparation for inguinal hernia repair involves the following steps-
- You have to avoid eating or drinking anything at least 6-8 hours before the surgery.
- Give the list of medications that you take on a regular basis to the doctor so that he/she can adjust the medications accordingly. Some medicines can react with anesthetic agents and may cause reactions in the body. Thus, it is important that the medicines are checked and adjusted before the surgery if required.
- Avoid taking aspirin, blood thinners, or anti-inflammatory medications at least a week before the surgery.
- Get evaluated properly to eliminate the chances of any underlying medical condition that can impact the outcome of the surgery.
- Take a shower on the day of surgery and wear loose and comfortable clothes that don’t restrict your movement or rub against the body.
- Ask a friend or family member to accompany you on the day of surgery.
The different techniques that can be used for inguinal hernia repair are-
Open Surgery- It is the traditional approach to repair inguinal hernia and other types of hernia too. It involves making a large incision around the groin region to access the herniated organ. The bulging organ is pushed back, and the perforation in the wall is repaired with or without using hernia mesh.
Laparoscopic Surgery– It is a comparatively advanced procedure that involves repairing the inguinal hernia with the help of a laparoscope (a device that has a camera connected to an end). The procedure is minimally invasive in nature as keyhole-sized incisions are made across the abdomen and groin region. The herniated organ is pushed back, and the hole in the muscle wall is repaired with or without hernia mesh.
Robotic Surgery– This technique is quite similar to laparoscopic hernia repair except that the procedure is carried out by robotic arms. The surgeon controls the robotic arm using a console and handles the surgical instruments.
All three techniques of hernia repair are effective in treating the condition. Generally, robotic surgery is performed on children for safety reasons, and laparoscopic hernia repair is preferred for adult patients who don’t want a large scar from the procedure.
Diagnosis
An expert doctor can identify an umbilical hernia through a physical examination. He/she will ask you to cough while sitting, standing, and lying down to check the bulge.
The doctor will also ask for your medical history to narrow down the exact cause of the umbilical hernia.
The following tests will be recommended to identify the severity of the umbilical hernia and to determine the most appropriate path to perform the surgery.
- Abdominal ultrasound is performed for a complete assessment of the condition and its severity.
- CT scan is performed to create a clear image of the internal organs and to distinguish the bulging tissues and abdominal tissues.
- MRI scan is used to narrow down the safest path for surgical repair.
Based on the results of these imaging tests, the doctor will determine which technique is safer and more effective for umbilical hernia treatment.
Procedure
Once everything is ready, you will be taken to the operation theater (OT) and anesthesia will be given to numb the surgical site. The type of anesthesia is chosen based on the technique decided for umbilical hernia repair, either open or laparoscopic. General anesthesia is used when laparoscopic hernia repair is being performed, and local/regional anesthesia is used for open repair.
As soon as the anesthesia takes effect, the following steps are carried out-
- Incisions are made around the abdomen to access the internal organs. In open repair, there will be a large size incision. But in laparoscopic repair, small keyhole-sized incisions are made to insert the surgical tools.
- The herniated tissues or bulge portions are pushed back to the original location, and the hole is closed with or without the help of mesh. Either the sides of the hole are stitched together, or mesh is placed over the tissues for support.
- After the muscle repair is done, the incisions are closed with the help of stitches, surgical glue, or staples.
Shortly, you will be transferred to the observation room until the anesthesia wears off, and then you’ll be moved back to the ward.
All hernia surgeries have somewhat similar complications during the procedure. It includes-
- Reaction to anesthesia
- Damage to the nerves, blood vessels, and muscles
- Bleeding
- Infection
In addition, there are also some risks of getting post-surgery complications until the recovery is complete. The potential complications are-
- Mesh infection
- Pain in the wound or stitches
- Fluid accumulation or seroma
- Blood accumulation or hematoma
- Wound infection
- Urinary retention
- Recurrence
To even reduce the chances of these complications, the doctor will create a detailed plan that will contain detailed instructions for a faster and smoother recovery.
To prepare for umbilical hernia surgery, follow the steps below-
- Avoid eating or drinking anything at least 6-8 hours before the surgery.
- Provide a list of medicine to the doctor so that he/she can make the necessary adjustments to prepare the body for surgery.
- The anesthetist will ask a series of questions to analyze which anesthesia will be appropriate to use during the procedure.
- The doctor will ask to stop taking aspirin, blood thinners, anti-inflammatory medicines, etc., for at least a week before the surgery as they increase the potential risk of bleeding.
- Get a full-body checkup to eliminate the risk of any underlying condition that can compromise the outcome or success rate of the surgical repair.
- Take a shower and wear loose and comfortable clothes before being admitted to the hospital.
- Ask a friend or family member to stay with you.
- Almost like every other surgical procedure, you will have to refrain from consuming anything for at least 8 hours before the surgery. An empty stomach would make it easier for the doctor to have a clear view inside your abdominal cavity, ensuring a safe and effective treatment.
- It is important to consult your doctor if you are going through any medications, and the doctor can accordingly assist you in how the medicines should be taken before and after the surgery.
- You will have to avoid taking certain drugs like aspirin, blood-thinners, vitamin E, and arthritis medicines prior to a week before the surgery.
- If you have a history of bleeding disorders or are allergic to anesthesia, it would be a wise decision to let your doctor know about it before going for surgery.
- Upon reaching the hospital, you might be required to go through certain medical evaluations like blood tests, chest x-rays, and other tests in order to eliminate any potential complications during the surgery.
- If you plan on taking a shower, you should make sure that you take it before going for the surgery, as doctors recommend keeping the surgical area dry after the operation, which helps to avoid infections and other complications in the wounded area after the surgery.
After the appendix operation, you can expect slight pain, discomfort, and disorientation until the effects of anesthesia completely wear off.
Once the anesthesia wears off and your blood pressure, breathing, and pulse rate are stable, you will be moved to the recovery room. Depending upon your overall physical condition and the procedure of the treatment, you will be prepared for a discharge from the hospital.
You will be advised to keep the surgical area dry and clean for the next few days to avoid possible infections in the wound.
During the first few days after undergoing an appendectomy, you may feel moderate pain in the areas surrounding your abdomen, and the doctor will accordingly prescribe antibiotics to deal with the pain and prevent any further infections.
Patients and doctors prefer laparoscopic appendix removal surgery because it has the following advantages over open surgery-
- Instead of 1 large incision, the laparoscopic technique involves making 1 to 3 keyhole-sized incisions that are comparatively smaller. Thus, the damage inflicted on the skin tissues becomes significantly less.
- As the size of the incisions is small, there are fewer chances of bleeding or infection during and after the surgery.
- Again due to the small size of the incision, the post-op pain is minimal.
- The patient recovers quickly as the tiny incisions will heal faster than a large incision.
- With laparoscopic appendectomy, the patient gets discharged from the hospital on the same day.
- There will be fewer restrictions on physical activities after having a laparoscopic appendectomy.
- In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:
- pain in the abdomen and back. Pain is generally infrequent, but severe
- increase in abdominal pain after eating a fatty meal
- jaundice
- fever and pain, if the gallbladder or bile duct becomes infected.
There are three main types of gallstones being:
- mixed stones – the most common type. They are made up of cholesterol and salts. Mixed stones tend to develop in batches
- cholesterol stones – made up mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow large enough to block bile ducts
- pigment stones – bile is greenish-brown in colour, due to particular pigments. Gallstones made from bile pigment are usually small, but numerous.
Doctors diagnose gallstones by using a number of tests, including:
- general tests – such as physical examination and x-rays
- ultrasound – soundwaves form a picture that shows the presence of gallstones
- endoscope test – endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures
- hepatobiliary iminodiacetic acid (HIDA) scan – a special type of nuclear scan that assesses how well the gallbladder functions
- magnetic resonance cholangiopancreatography (MRCP) – a form of the body-imaging technique magnetic resonance imaging (MRI). The person’s liver, biliary and pancreatic system is imaged using an MRI unit. The image is similar to an ERCP test.
What is Gallstones surgery?
