Endoscopic Total Extraperitoneal Hernia Repair

WHAT YOU SHOULD KNOW:

• A hernia may occur when the muscle layers in your abdomen weaken. The weakened muscle layers allow your tissues or organs to push through. When this happens, a bulge or mass may be seen or felt under your skin. Hernias often occur in your inguinal (groin) area. A hernia may also occur near your genital area, or upper thigh. Hernias may also form in the front of your abdomen, or in areas of past surgical incisions.
  
  
• You may need surgery to repair the abnormal opening in your muscles. Your caregiver may do an endoscopic total extraperitoneal (TEP) hernia repair. Many forms of hernia repair are done through your peritoneal cavity (the space in your abdomen containing the organs). An endoscopic TEP hernia repair is done without entering your peritoneal cavity. Small incisions are made to reach your hernia area. A scope and special tools are placed through your incisions to fix your hernia. A scope is a bendable tube with light and camera on the end. A synthetic (man-made) mesh will be put through the scope to cover your weak muscle layers. Endoscopic TEP hernia repair may strengthen your abdominal muscles, remove your hernia bulge, and decrease your pain.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may be allergic to the anesthesia used during your surgery. Anesthesia medicine may also cause an upset stomach, headaches, low blood pressure, and a slow heart beat. You may have bruising, seroma (collection of fluid), swelling, or infection at your surgery site. A deep infection may also occur from the mesh patch used. You may have trouble emptying your bladder after surgery. You may have shoulder and chest pain from the gas used during your surgery. In some cases, a TEP hernia repair may need to be changed into an open hernia repair surgery. An open surgery means larger and deeper incisions will be made which will take longer to heal.
  
  
• During your surgery you may have injuries to your nerves, blood vessels or abdominal organs. You may also have chronic (lasting) pain or numbness in your groin area for months or years after your surgery. You may need to have another surgery if your condition returns or occurs in a different area. If you do not have the surgery, your pain or discomfort may increase. Your soft tissues or bowels may become trapped in your abnormal opening. When tissues and organs are trapped they may become necrotic (tissue death). Trapped necrotic tissues and organs may be life-threatening. Talk to your caregiver if you have questions about your condition, surgery, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your surgery to make you feel relaxed and sleepy. Antibiotic medicine may also be given through your IV to prevent infection. You will be taken on a stretcher to the room where your surgery will be done. You will then be moved to an operating table or bed.
  
  
• Anesthesia: Anesthesia is medicine that will help keep you comfortable during your surgery. Your caregiver will work with you to decide which anesthesia is best for you.
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal (ET) tube. Usually, you are asleep before your caregiver puts the tube into your throat. The ET tube is usually removed before you wake up. With this anesthesia, you will be completely asleep and free from pain during surgery.
    
    
  • Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.
    
    
  • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

During your surgery:

• Your caregiver will make a small incision under your umbilicus (belly button). Your abdominal muscles will be secured to the sides of your incision. Your caregiver will make a tunnel under your skin and muscle to reach the area of your hernia. A device with a special balloon may be put into your incision. The balloon will be inflated (filled with air) to create a space outside your peritoneum (the lining of your peritoneal cavity).
  
  
• The balloon is then removed and the space may be filled with carbon dioxide gas. The gas will allow your caregiver to better see the area in need of repair. One to 2 more small incisions may be made where a scope and other devices can be put through. A synthetic mesh is inserted to cover your weak muscles, and push your tissues and organs back into place. The mesh is secured in place and the tools are removed. Your incisions will be closed with stitches. A bandage will cover your incisions to keep them clean and dry. A bandage will also help prevent infection from germs called bacteria.

After your surgery:

• You will be taken to a room to rest until you are fully awake and feeling returns in your lower body. Once caregivers see that you are OK, you may be able to go home. If your caregiver wants you to stay in the hospital, you will be taken to your room. Do not get out of bed until your caregiver says it is OK.
  
  
• Activity: A caregiver may help you get out of bed to walk on the day of your surgery. Ask your caregiver if there are exercises that you can do while you are in bed. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be given a high-fiber diet to prevent straining (pushing) during bowel movements. You may need to drink more liquids after your surgery.
  
  
• Medicines:
  
  
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.