POSSIBLE COMPLICATIONS AFTER LAPAROSCOPIC SURGERY
These can be grouped according to whether they are possible complications after any surgical procedure and anaesthetic, immediate post operative complaints and possible long term complications.
Operative and anaesthetic complications
Heart and chest problems can occur in the unfit after a general anaesthetic. These would include heart attacks, blood clots in the legs with spread to the lungs, both of which could be fatal. Collapse of the lung bases with pneumonia after anaesthetic is possible, more likely to occur in the unfit or smokers. If there are serious medical problems an open inguinal hernia repair is more often utilized as local anaesthetic methods can then be used. Laparoscopic hernia repair always requires a general anaesthetic.
Inability to pass urine This is due to spasm of the bladder sphincter. It may require a catheter or tube to be inserted into the bladder. Occasionally a subsequent prostate operation can be required if the prostate gland is very large and urine cannot be passed. It is usually preferable to have any necessary prostate surgery prior to embarking on an inguinal hernia repair.
Local expectations and complications
Swelling at the hernia site is not uncommon as the space taken up by the hernia is filled with fluid. It resolves within a short time but sometimes patients think the hernia is still present after surgery.
Bruising of the groin or scrotum is very common – a little blood causes much discolouration.
Haemorrhage around the incision sites occasionally leads to a small tender firm lump which resolves with time.
Infection of the incisions of hernia repair is extremely rare.
Scarring of wounds. In some persons scars can become raised and angry, where as scars usually fade progressively with time.
Potentially Serious Complications
Damage to other structures. Mishaps could occur. For example, the bladder could be punctured or a relatively large blood vessel in the abdominal wall could be punctured leading to total loss of view. In such a rare event an open operation may be required to repair any damage and the hernia. As the true abdominal cavity is not entered in the operation there should be little or no risk of damage to any organs or of post operative problems long term.
Adhesions causing long term bowel problems. The peritoneal cavity lies just behind the mesh and usually bowel does not adhere to the mesh. Should there be unrecognised holes in the peritoneum and mesh adheres to bowel it is possible that obstruction or perforation of the bowel can develop within a year or so of insertion of the mesh. This is a theoretical remote possibility rather than being a recognized complication.
Rupture of the bowel with peritonitis. There have been two incidents of this life threatening mishap occurring in Brisbane. This complication is not usually mentioned in hernia surgical conferences or literature. In both patients there had been previous intra-abdominal problems with infection such as diverticulitis or surgery for severe appendicitis. The large bowel had become adherent to the peritoneal lining layer. The balloon used to create the space when distended caused the large bowel to rupture. This is not visualized at surgery, as the true abdominal cavity is not entered, and therefore the delayed recognition of the peritonitis has led to a critical illness, with major surgery being required. There is a very slight risk of this occurring as very large numbers of laparoscopic operations have been performed worldwide. The complication can cause death, and this is not a risk one would consider with an open operation rather than laparoscopic.
Damage to the vas deferens. The vas is the tube carrying sperm from each testis. Should both of these be damaged then infertility would result. This is an extremely low risk as only a few cases have ever been reported. The risks of sterility would of course be much higher if the patient had only one functioning testis.
Damage to the testicular blood supply. Similar to the above, again a very rare complication, which would result in loss of testicular and therefore sexual function, if both testes were non-functioning.
Nerve damage. A number of small nerves run transversely across the abdominal wall within the muscle layers and these cannot be seen with the laparoscope. Pinching one of these nerves with staples or tacks, can cause on going problem with sharp stabbing This is unusual as the nerves lie between the 1st and 2nd of the abdominal muscle layers, and the mesh and tacks are deep to the 3rd layer of the muscles. Should such pain from nerves occur often it can be settled by one or more injections of long acting steroids. On rare occasions further surgery to remove the offending tack may be required.
Mesh Inguinodynia. In rare occasions an unusual tissue inflammatory reaction can occur in isolated patients causing mesh to contract and constrict surrounding structures. This can result in chronic pain. One variety of this is where a vas deferens may be affected by inflammation around mesh resulting in pain on ejaculation. The risk is probably less after laparoscopic surgery than in open surgery.
Problems with future prostatic surgery. Scarring after surgery and mesh insertion is how healing and tissue strength results. For a surgeon to revisit the anatomical space behind the muscles makes any future prostatic cancer surgery in this region extremely difficult for the urologist. For that reason patients with prostate problems or with a family history of prostate cancer should probably avoid laparoscopic groin hernia surgery. Remember 50 years or more can elapse before prostate cancer surgery becomes a consideration.