Endoscopic Total Extraperitoneal Hernia Repair

What you should know

• A hernia may occur when the muscle layers in your abdomen (stomach) weaken. The weakened muscle layers allow your tissues or organs to push through. When this happens, a bulge or mass (lump) 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 (between your inner legs), or upper thigh. Hernias may also form in the front of your abdomen, or in areas of past surgical incisions (cuts).
  
  
• 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.

Getting Ready

Before your surgery:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Tell your caregiver if you are allergic to any medicine. If you are taking anticoagulation medicine, you may need to stop taking it a few days before your surgery. You may also need to stop using aspirin and any other prescribed or over-the-counter medicines. Tell your caregiver if you use any herbs or food supplements. Bring your medicine bottles or a list of your medicines when you see your caregiver.
  
  
• You may need to have an abdominal ultrasound or computed tomography (CT) scan. This is to help your caregiver learn more about your condition. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.

Night before your surgery:

• Ask your caregiver about directions for eating and drinking.
  
  

Day of your surgery:

• Write down the date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken on a stretcher to the room where your surgery will be done. Medicine called anesthesia will be given to keep you free from pain 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 then 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. Once your 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.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You get sick (a cold or the flu).
  
  
• You have a fever (high body temperature).

Seek Care Immediately if

• You have an upset stomach or start to throw up.
  
  
• Your hernia area suddenly becomes very painful.
  
  
• Your lump increases in size, or you are not able to gently push it back into your abdomen.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.