Other Conditions treated by Mr Horner

An abdominal incisional hernia occurs in up to 5% of all cases after previous major abdominal surgery.
Where an incisional hernia recurs after a previous incisional hernia repair, the risk of a further recurrence can be as high as 40-50%.

The use of a mesh when repairing an incisional hernia, is usually advised to reduce tension in the wound when repairing such a hernia, to reduce the risk of a further recurrence.

Usually an open incisional hernia mesh repair, requires an extensive reopening of the abdominal wound and scar, in order to identify the extent of the hernial weakness, and to then suture in a place the mesh to obtain a secure and firm closure.

Both the extent of the surgical incision and the risk of the wound infection occurring are factors, which need to be considered when using an open mesh repair.

Inpatient hospital stays after open incisional hernia repair, depending on the size and extent of the incisional hernia defect, can be lengthy, and hosptal stays of 7 to10 days is not unusual.

With a laparoscopic mesh repair of an incisional hernia, only 3 or 4 small incision are made in the patients flank through which laparoscopic instruments are inserted.

A special double-layered mesh, designed so as to be non-adherent and reduce adhesions to the underlying bowel, is inserted into the abdomen and positioned exactly over the hernial defect.

These meshes are stapled in place from within, and additional stay sutures are placed to keep them positioned over the incisional hernia defect, with the pressure exerted against the mesh from within maintaining the mesh in position.

Patients operated on laparoscopically for an incisional hernia, can usually be discharged within 24 to 36 hours of their surgery, and return to normal activity within 2 to 3 weeks.

Mesh repair of an inguinal hernia has now become the standard method used to treat this most common surgical problem.

The laparoscopic mesh technique to repair a groin hernia is analogous to placing a patch on the inside of a bucket of water to prevent a leak, or a canvas patch to the outside of a boat to prevent water entering, The pressure of the water over the hole helps to keep the patch in place.

This is the mechanical advantage obtained by laparoscopic repair of inguinal and groin hernias, where the special mesh is stapled or sutured on the inside of the abdominal musculature overlying the hernia weakness or defect.

The minimal incisions required, the technical ease of mesh placement, the rapid postoperative recovery with significantly less pain and an almost zero rate of mesh infection, are hallmarks of this procedure. In more than 1500 cases performed by Mr Horner, he totally is convinced as to the value of this type of surgery in groin hernia repair.

Laparoscopic hernia repair for all types of inguinal hernia, has been fully endorsed by The National institute for Health and Clinical excellence (NICE).

The laparoscopic approach is especially suitable for treating bilateral hernias. Both sides can be repaired using the same 3 small abdominal incisions for the laparoscopic instruments.

Previously unrecognized hernias are identified in up to 10% of planned unilateral groin hernia repairs, Such a contra-lateral hernia (a hernia on the other side) when identified, can be attended to during the same procedure, with minimal or no extra discomfort to the patient.

Laparoscopic groin hernia repair is undertaken under general anesthesia, and in the majority of cases is completed as a day case, with patients returning home within 4-5 hours of their surgery.

It is usual for patients to return to normal activities within 10-12 days of their surgery.

Where groin hernias have recurred after previous surgery, the scarring and anatomical distortion that results may increase the risk of an injury to the blood supply and other structures in the cord of the testicle. Redo operations for recurrent inguinal hernias are recognized to have an up to 5% risk of testicular ischaemia, with the resultant in loss of the testes.

Undertaking a laparoscopic repair for a recurrent inguinal hernia enables the laparoscopic surgeon to operate in a virginal and non-scarred area as viewed from within the abdomen, and for the hernia to be rapidly and effectively repaired with minimal risk to the testicle.

In all respects Mr Horner believes, in his experience, that the outcomes following a laparoscopic inguinal hernia repair are superior to the open procedure.

The laparoscopic hernia repair however, does have to be performed under a general anesthetic, and for optimal results requires a surgeon experienced in the technique.

Heartburn caused by gastro-oesophageal reflux is all to common a problem. It results from the stomach contents, which contains acid and gastric juices, being regurgitated up the oesophagus, and causing inflammation to the lining of the esophagus. Sufferers can also experience chest pain, vomiting, hoarseness, chronic cough (especially at night) and asthma-like symptoms. There usually also is an associated hiatus hernia.

Weight loss, avoidance of large volume alcoholic drinks late in the evening, and use of medication, are usually sufficient to help alleviate the problem.

However, when these symptoms persist, and if, only through the continued use of powerful acid blocking drugs can relief be obtained, it may be worth while seeking advice with regard to a permanent surgical cure.

After you have discussed your problem of acid reflux and GORD with your GP, Mr Horner would be happy to see you on consultation, to discuss further whether you might be suitable for an anti-reflux operation. Laparoscopic surgery is the treatment of choice for this illness, when symptoms are very severe, or fail to respond to medical treatment.

What causes GORD?

The most common reason for patients to develop heartburn or other symptoms of GORD, is due to a defective lower oesophageal sphincter (LOS). The LOS is a complex valve system at the lower end of the esophagus, and when functioning properly, prevents the acid and enzymes of the stomach from going up into the oesophagus. There are other reasons for the symptoms, that must be identified before undergoing surgery, and which will require assessment by preoperative tests. The hiatus hernia, so frequently present in patients with GORD, is repaired at the same time.

How is Laparoscopic Surgery for GORD performed?

The operation is performed under general anaesthesia. After the abdomen is insuflated with carbon dioxide gas, five small incisions made in the upper abdomen through which Mr Horner will pass a laparoscopic telescope, and fine laparoscopic instruments. The laparoscope is a fiber-optic telescope that is connected to a high-resolution video camera. Mr Horner will now get an excellent view of the abdominal cavity and the area to be repaired, from the images on a television monitor. The weakness in the diaphragm ( the hiatus hernia), is strengthened by sutures, and the top part of the stomach is wrapped around the lower end of the esophagus (fundoplication). This produces an effective valve mechanism that stops the reflux of gastric contents into the esophagus. The carbon dioxide gas gas is removed from the abdomen at the end of the procedure, and the small incisions are closed with skin tape and skin glue.

What can I expect after Laparoscopic Surgery for GORD?

• You will be able to drink clear fluids within four hours of surgery, and be out of bed and walking about, the same evening.
• You will usually be able to be discharged the following morning.
• There is usually minimal discomfort, and the majority of patients get sufficient pain relief with oral medication.
• You should be fit to return to normal activities in 10 to 12 days.

What are the benefits Laparoscopic Surgery for GORD/ Hiatus Hernia

• Most patients are discharged the day after surgery 99% of the time.
• Most patients are back to normal activity within 10 days to two weeks.
• The operation is effective in relieving symptoms in approximately 95% of patients.
• You should be able to stop all anti reflux medication after surgery.
  

Are there any side effects of surgery?

There are 2 common side effects, which you will need to be aware of :

• An occasional difficulty in being able to belch, otherwise known as gas bloat. This may persist for some time.
• Difficulty in swallowing solid of food. This in usually temporary, and if it occurs, almost always disappears within 6 weeks.

Am I a candidate for a Laparoscopic repair of my Hiatus Hernia?

If you are suffering from any of the above symptoms, and you would like to stop the endless taking of acid suppressing drugs, Mr Horner will be pleased to meet with you at consultation, and discuss any or all the issues mentioned above, with you. Contact Us.

Further Reading

 http://en.wikipedia.org/wiki/Hiatus_hernia

The gallbladder is a small, pear-shaped organ positioned under the liver in the upper right portion of the abdomen.

Its main purpose is to collect and concentrate bile, to help with the digestion of fat.
Stones may form in the gallbladder, and can block the outlet of the gallbladder, so causing pain.
Sometimes the stones may move into the bile duct, causing jaundice or an inflammation of the pancreas (pancreatitis).

Patients who have severe symptoms from gallstones (usually diagnosed on an ultrasound) usually have to have their gallbladder removed.

Symptoms may include sharp abdominal pain, vomiting, and indigestion.

Gallbladder pain may start after a meal, and it may be a severe, steady pain, an intermittent severe colicky pain, or even a low grade upper abdominal discomfort, occurring after meals.

If left untreated, symptoms often worsen.

Sometimes very mild gallbladder problems can be managed with medication or dietary changes.

However, when severe pain or infection occurs, removal of the gallbladder is the only option for a long-term cure, and to prevent future life threatening complications.

How is Gallbladder surgery performed?

Mr Horner has to date, performed in excess of 2500 laparoscopic gall bladder procedures.
Under a general anaesthetic, the abdomen is insuflated with carbon dioxide gas, to allow Mr Horner a better view of the operative area.

Mr Horner will then insert 4 small laparoscopic instruments into the upper abdomen through 4 small cuts.
One of the instruments, a laparoscope, is connected to a video camera, and this allows Mr Horner to have an excellent view of the inside of the abdomen, on a television screen.

The three additional small incisions made, are for the passage of very fine, specialized surgical instruments, used to remove the gallbladder.

Mr Horner always examines the bile duct with an Intra-operative cholangiogram, to be absolutely sure of the anatomy, and to ensure that no stone has travelled down from the gallbladder into the bile duct.
Following the procedure, and after removal of the gallbladder through one of the small incisions, the gas is also removed, and the small wounds are closed with skin glue and small skin strips.

These wounds, will be hardly visible within a few months.

Postoperative Expectations

You should expect to be discharged within 24 hours of your surgery, and to gently mobilize after your return home.

It is usual to be back to get back to normal activities within 2 weeks of surgery.
Complications are very unusual, but if the gall bladder has been very inflamed and infected, a slower recovery should be expected.

Further Reading

 http://en.wikipedia.org/wiki/Cholecystectomy