Specialist Surgeon
Life St George’s Hospital
Port Elizabeth

Laparoscopic surgery, also called minimally invasive surgery (MIS), band-aid surgery, or keyhole surgery, is a modern surgical technique in which operations are performed through small incisions (usually 0.5–1.5 cm) elsewhere in the body.

ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is a procedure that enables your physician to examine the pancreatic and bile ducts. A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum).

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumours and other disorders of the pancreas, intestine and bile duct.

Hernia repair refers to a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it.

During surgery to repair the hernia, the bulging tissue is pushed back in. Your abdominal wall is strengthened and supported with sutures (stitches), and sometimes mesh. This repair can be done with open or laparoscopic surgery. Dr Brombacher does most hernia repairs laparoscopically.

There are different types of hernia’s.

INGUINAL HERNIA

Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region.

UMBILICAL HERNIA

Umbilical hernia repair surgery is a procedure that fixes umbilical hernias. An umbilical hernia involves a bulge or pouch that forms in the abdomen. This type of bulge occurs when a section of the intestine or other abdominal cavity tissue pushes through a weak spot in the abdominal wall near the belly button.

VENTRAL (INCISIONAL) HERNIA

A ventral or incisional hernia specifically describes a hernia, often in the middle of the abdomen, that occurs after a prior incision was made during a prior operation. The size of the hernia varies considerably from small to gigantic.

Signs and Symptoms of a ventral hernia include:

• A small to large bulge at or near an old surgical incision, most commonly along a vertical straight incision on the abdomen.
• Discomfort or sharp pain-especially when straining, lifting, or exercising-that improves when resting
• A burning, gurgling, or aching feeling at the bulge.
• Intestinal obstructions can occur when the intestines are blocked due to scar tissue.

Potential Complications with Hernia Repairs

Risk of general anesthesia. Before surgery, the anesthesiologist-a doctor who administers anesthesia-reviews the risks of anesthesia with the patient and asks about medical history and allergies to medications. Complications most likely occur in older people and those with other medical conditions. Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs.

• Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots.
• Hernia recurrence. A hernia can recur up to several years after repair. Recurrence is the most common complication of inguinal hernia repair, causing patients to undergo a second operation.
• Bleeding. Bleeding inside the incision is another complication of inguinal hernia repair. It can cause severe swelling and bluish discoloration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 percent of patients.
• Wound infection. The risk of wound infection is small-less than 2 percent-and is more likely to occur in older adults and people who undergo more complex hernia repair.2 The person may experience a fever, discharge from the incision, and redness, swelling, or tenderness around the incision. Postoperative infection requires antibiotics and, occasionally, another procedure requiring local anesthesia to make a small opening in the incision and drain the infection.
• Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Medicine may be injected in the area if the pain continues.Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys, nerves and blood vessels leading to the legs, internal female organs, and vas deferens-the tube that carries sperm-can occur during hernia surgery and may lead to more operations.

HIATUS HERNIA

When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-oesophageal reflux: GORD) as gastric acid backflows from the stomach into the oesophagus. Hiatal hernia repair is surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).

Hiatal hernia repair may be recommended when the patient has:

• Severe heartburn.
• Severe inflammation of the oesophagus from the backflow of gastric fluid (reflux).
• Narrowing of the opening (hiatus) through the diaphragm (oesophageal stricture).
• Chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids.

Procedure

The stomach and lower oesophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the oesophagus (fundoplication) to reduce reflux.

*Dr Brombacher requires his patients to follow a strict diet for 6 weeks after Hiatus Hernia repair surgery.

• Cancer Surgery – Breast, intestinal, thyroid, adrenal, stomach, skin and various others.
• Endoscopic Services – Gastroscopy, Colonoscopy.
• Gallbladder Surgery – Laparoscopic Cholecystectomy.
• Hernia Surgery – All types of abdominal hernias including inguinal, umbilical, incisional, hiatus and other unusual hernias.
• Breast Surgery – treatment of breast disease, lumps and malignancies.
• Endocrine Surgery – Thyroid, adrenal, parathyroid.
• Abdominal Surgery – Surgery related to appendix, gastro-intestinal system.
• Emergency Surgery/ Trauma Surgery
• Obesity/Bariatric Surgery – Laparoscopic Sleeve Gastrectomy.