Ch. 7: PATIENT EDUCATION: AVOID MISUNDERSTANDINGS
The surgeon who performs your hernia repair should educate you with enough information for you to confidently participate in the decision-making processes. Because one repair does not fit all patient’s requirements, explanation of the options of treatment and description of the alternative techniques require an orderly two-way communication including verbal and visual descriptions of techniques, clarification of ambiguities and misconceptions, establishing realistic expectations, and evaluation of risks and benefits, advantages and disadvantages. You may have special needs or conditions that require integration into the equation including fears, past surgical experiences, coexisting medical risk factors, employment needs, exercise habits, cosmesis and psychological predisposition. Institutional cost factors will impact in addition to limits established by insurance companies and HMOs.
The Paradox: The factors leading to the choice of Open incisional repair and Laparoscopic repair are paradoxical. Because laparoscopy is also called "minimally invasive” one might think that it is simple, doesn’t need much anesthesia, is safer and is better done when risk cofactors such as heart disease or urinary problems coexist. Laparoscopy is actually “minimally incisional” but the procedure is performed is a deeper and wider space with more dangerous and sensitive structures in the neighborhood. General anesthesia is needed and the risk of most coexisting medical conditions is magnified. The bigger cut and superficial dissection of the standard incisional techniques however are closer to the surface and can dependably be performed with local anesthesia and less risk from coexisting conditions.
Laparoscopy is not the same as LASER. Laparoscopy is a method of access and visualization with a few small incisions. LASER is a method of energy deliverance that is used in place of knife or cautery. Some patients have been led to believe that a LASER can magically perform this operation without an incision.
Surgeons need to talk about these things…otherwise these things will be very confusing.