LAPAROSCOPIC SURGERY FOR CHILDREN

All kinds of hernia can now be treated using laparoscopy:

Inguinal Hernias
Ventral Hernia / Incisional Hernia
Diaphragmatic Hernias
Hiatus Hernia etc.

INGUINAL HERNIA

In this part of the intestine, fat, etc. protrudes through a weak spot in the abdominal muscles in the inguinal region (near the junction of belly and thigh). This results in a lump that can be felt initially but as it becomes bigger, it can be seen as well. It may disappear or reduce in size on lying down (as during sleep) and reappear on doing work (especially after coughing or lifting heavy weights).
There is no cure for hernia without surgery. Once detected, it is recommended to get it operated on as it may complicate any time into a life-threatening situation.

Symptoms

Swelling in the groin area becomes more obvious in a standing position, especially on coughing
A burning or aching sensation at the bulge
Dragging sensation in the abdomen
In children
Inguinal hernias can be seen in newborns and children due to weakness in the abdominal wall that’s present at birth, especially in males. Testicles develop in the abdomen and later descend into the scrotum which leads to weakness in this area. Sometimes hernia is visible only when a child is crying, coughing, or straining.
When to see a doctor immediately
If you know you have a hernia and you experience the following:
Sudden severe pain
Nausea, vomiting, or both
Fever
The skin over the hernia turns red, purple, or dark

Causes

The cause is not always apparent but may include:
Prolonged cough
Prolonged constipation
Urinary difficulty
Strenuous activity
Pregnancy
Old age leads to muscle weakness

Complications

Big hernias are difficult to repair and have a higher recurrence rate. As time passes, most hernias grow in size and become more difficult to repair, and are also more prone to come back again after surgery.
Incarcerated hernia. If the contents of the hernia become trapped, it can obstruct the bowel, leading to severe pain, nausea, vomiting, etc. It may cause an inability to pass flatus.
In extreme cases, blood flow to part of the intestine gets cut off leading to the death of that area. The intestine may get a hole here leading to the spread of dirty fluid all inside the abdomen. This is a life-threatening condition and requires immediate surgery.

Prevention

A hernia is not entirely preventable but certain modifications may decrease your chances of getting one.
Maintain a healthy weight
High-fiber food
Avoid lifting heavy objects
Quit smoking – causes muscle weakness and cough

Diagnosis

Usually, a hernia can be diagnosed by a doctor by just examining the patient. In cases of doubt, a scan may be required like USG, CT, or MRI.

Treatment

A very small hernia that is not causing any trouble may be left untreated but under watchful eyes.
Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.
There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Open hernia repair

In this procedure, a cut is made in the groin area at the site of the hernia. The protruding tissue is pushed back and a mesh is kept over it to strengthen that area. The opening is then closed with stitches, staples, or surgical glue.
After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.

Laparoscopy

In this minimally invasive procedure (keyhole method). There will not be any direct cut on the hernia site. Instead, there will be very small cuts elsewhere on the abdomen through which a camera and instruments will be inserted.
A much bigger mesh is employed after folding it and inserting it through a small hole. People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. Having a surgeon who is very experienced in the laparoscopic procedure may reduce the risk of getting a hernia back.
Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after open hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral) as both sides can be operated from the same small holes whereas in open surgery two big separate cuts will be required.
Laparoscopic surgery is also possible for small kids and helps them recover fast and with smaller scars.
Pain may be lesser, and return to work quicker in the keyhole surgery method.

VENTRAL HERNIA

Ventral Hernias – Umbilical Hernia, Epigastric hernia, incisional hernia
Umbilical hernia – Our umbilical cord passes through the umbilicus before birth and this leaves a potentially weak area here. These are most common in infants, but they can be seen in adults as well.
Children’s umbilical hernias often close on their own in the first two years of life. Umbilical hernias in adults are more likely to need surgery.
Incisional Hernia
This occurs from the weakness caused by the cut of previous surgery. It is much more common after open surgery as compared to laparoscopic surgery.
Epigastric hernia – It is seen above the level of the umbilicus
Suprapubic hernia – This is seen below the level of the umbilicus

Symptoms

A bulge at the navel which becomes worse when the baby cries is the most common symptom in kids.
In adults, one may feel hollow at the umbilicus or other places on the abdomen (excluding the groin which is called an inguinal hernia). A bulge may be seen or felt there that becomes worse on coughing. In later stages, a bulge may just stay there all the time and may cause pain.

Complications

When the bulging abdominal tissue (intestine or fat) becomes trapped in the hernia hole, it can reduce the blood supply to the section of the trapped intestine or fat and can lead to pain. If the trapped portion of the intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdomen leading to a life-threatening situation.

Treatment

Most umbilical hernias in babies close on their own by age 1 or 2.
Children may require surgery if hernias:
Are painful
Are slightly larger than 1 to 2 centimeters in diameter
Are large and don’t decrease in size over the first two years of life
Don’t disappear by the age of four years
Become trapped or block the intestine
For adults, surgery is typically recommended soon after diagnosis to avoid possible complications. If a hernia becomes painful or shows other signs of complications, then immediate surgery is recommended.

OPEN SURGERY

The cut is made at the site of the hernia. Contents are pushed back and the hole is closed with sutures. In adults, a mesh is usually placed to strengthen the abdominal wall. Open surgery involves a cut often bigger than the size of the hernia to make space for the mesh. In many cases, a tube is kept to drain fluid from the wound for a few days after surgery.