hernia complications of surgery

7/28/2019 Hernia Complications of Surgery

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COMPLICATIONS OF

HERNIA SURGERY

DR SRIRAM BHAT M MS

PROFESSOR IN SURGERYKMC MANGALORE


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Complications ofopen hernia surgery

Complications of TEP/ TAPP

Complications of

other hernia surgeryventral / femoral

Early

Delayed

Late

Life threatening


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Complications of open

hernia surgery

Infection

Neural - Groin pain

Ischaemic orchitis

Injury to vas

Injury to viscera Recurrence

Hydrocele

Seroma, haematoma Dysejaculation

Complications of TEP

/ TAPP /

laparoscopic

SC emphysema Pneumothorax,

hypercarbia

Vascular Neural

Visceral

Infection, ileus Conversion

Recurrence


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Immediate

Vascular

Visceral Vas

Anaesthetic

Late / delayed

Seroma / haematoma

Neural Intestinal obstruction

Bowel adhesion /

fistula Testicular

Mesh related

Recurrence


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Iliac vessels, IE

vessels areimportant


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INGUINODYNIA

Chronic inguinal pain in post herniasurgery patients whether tissue or meshrepair.

Traction, cautery, transection, entrapment.

It may be transient or persistent.

Iliohypo gastric, ilio inguinal, genitalbranch of GF nerve.


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Ilioinguinal N Iliohypogastric N


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Features

Distressing pain in thegroin

Radiates to thigh,

scrotum, loin

Arch and twistmobility of pelvis

reproduce the pain

Bupivacaine injectionrelieves the pain

Imaging / NCS is ofno use


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Open method has higher (32-38%)incidence of inguinodynia than TAPP /

TEP.

In open hernia surgery inguinodynia hasreplaced recurrence as a primary

complication.

It is distressing discomfort to both patientand surgeon.

Treated with analgesics / nerve block /transcutaneous stimulation / neurectomy.


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Mesh inguinodynia can occur.


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Treatment

Drugs

Reassurance

Injection of steroid,

LA agents, phemol,alcohol

TC stimulation

Cryo, RF

Neurectomy

Groin approach

Suprainguinal

Laparoscopic

Neurolysis


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PROBLEMS WITH TEP

Trocar injury, Bladder injury, bowel injury

Vessel injury IEA / Ext iliac vessels ,muscle branch, trocar site, spermatic

vessels. Beware of triangle of doom.

Injury to vas

Difficulties in placing mesh and withinstruments, peritoneum opening

Conversion to TAPP / OPEN


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TRIANGLE OF DOOM


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prea ng an x ng e mesis important to reduce

recurrence


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Seroma common 20-25%.

Nerve injury lateral cut nerve of thigh2%. It may be temporary (hyperaesthesia)

or permanent; latter causes life time

numbness along upper aspect of thigh andhip.

Femoral branch of genitofemoral nerveinjury (1%) - hyperaesthesia of scrotum

and femoral triangle; usually subsides.


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NervesTEP HaematomaTriangle of pain


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Mesh related problems displacement,infection, rejection.

Testicular complications

Surgical site infection

Recurrence missed indirect sac, folding

or displacement of mesh, small mesh,haematoma, infection


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MESH INFECTION

WOUND INFECTION


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RECURRENT HERNIA

Technical causes

Missed hernia

Precipitating causes Infection

True recurrence / false recurrence Medial / lateral recurrence


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S l i i f i d


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Strangulation infection andrecurrence rate is high

Only tissue repair is done


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Direct hernia whenpresent, indirect may

be missed.


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Shouldice 1-2%

Mesh repair 1-3%

Other methods 5%

TEP / TAPP 5-10%

Bassinis 10-20%. Treat with a new approach Lap / open

RE RECURRENT HERNIA 1%


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ISCHAEMIC ORCHITIS

Due to thrombosis of pampiniform plexus

Can be arterial very rarely.

Leads to testicular atrophy (0.5%).

DYSEJACULATION

Self limiting entity after hernia surgerydistressing pain just before, during and

after ejaculation RARE (0.25%).

INJURY TO VAS


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INJURY TO VASdirect injury is rare;

vas amalgamating in

mesh can occur.

Bilateral hernioplastymay rarely lead into

infertility


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Seroma / haematomais aspirated.

Bowel / bladder injurycan occur in large

irreducible hernia with

adhesions.

Urinarycatheterization is

better.


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COMPLICATIONS OF OTHER

HERNIA SURGERIES


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COMPLICATIONS OF

VENTRAL HERNIAOPEN METHOD

Ileus, infection,

Bowel injury, Intraabdominal sepsis

Difficulties in releasing adhesions.

Difficulties in mesh placement in front ofthe peritoneum.

Recurrence


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LAPAROSCOPIC VENTRAL

HERNIA REPAIRIntra operative

Related to access, inability to reducecontents, bowel injury, mesh insertion,

positioning, placing, fixing, bleeding.

Early post operative

Pain, seroma (20%), infection, ileus,retention of urine, delayed bowel injury


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TO BE REMEMBERED

EXACT ANATOMYvascular, neural,

fascial and muscular

METICULOUSDISSECTION

SELECTION OF THEPATIENT AND

PROCEDURE

CUTTING NERVE ontable IS NOT AN

ANSWER

CREMASTER excision

/ retaining iscontroversial byremoval protection to

nerves is andhanging testis like

clapper bell can occur.


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ALWAYS SEE AND CUT

ALSO CUT AND SEE


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Many patients feel after effect of herniasurgery is more distressing than hernia

itself.

Hernia surgery is a very common surgeryBUT NOT a simple surgery.


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THANK YOU

hernia complications of surgery

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