Hernia


What is Hernia?

When an internal content of the abdomen, be it an intestine or omentum or organ leaves its original position and comes out through a defect or weak spot in the sheath/ muscle of the abdominal wall containing it, it causes a swelling in that particular area. This swelling is called a hernia.






Types of Hernia:


This swelling could be over the tummy, groin, thigh or hiatus in the diaphragm and is named accordingly.


Umbilical or Paraumbilical hernia

When the swelling is around the umbilicus. Umbilical hernias are seen at all ages even at birth. These hernias more commonly seen in women and even more common after childbirth. When the contents reduce it is called a reducible hernia. When the contents don’t reduce into the abdominal cavity, it is called an irreducible hernia.


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Epigastric hernia :

When the swelling is seen in the upper abdomen in the midline, between the xiphisternum and the umbilicus. The content of this hernia is mostly fat, very rarely it may contain the colon which is the large intestine.

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Femoral hernia

When the swelling in the upper thigh. These are not very common.

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Inguinal hernia

When the swelling is in the groin it is called an inguinal hernia. It could be on one groin (unilateral inguinal hernia) or both groins (bilateral inguinal hernia). This is one of the commonest hernias seen both in males and females more common in females who are obese.
Inguinal hernia is of two types-
Direct inguinal hernia- The swelling over the groin is globular just over the Hesselbachs triangle.
Indirect Inguinal hernia: Initially, the swelling may be seen just in the groin region , but as it increases in size, the swelling appears in the scrotal region also called the inguinoscrotal hernia

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Incisional hernia-

When the swelling appears in the area or vicinity of previous surgery or scar, we term it as an incisional hernia. The scar could be that of an appendicectomy, or gall bladder surgery, hysterectomy ( uterus removal), caesarean section scar etc. When one undergoes abdominal surgery, all the layers of the abdominal wall are cut. This may cause weakness in that area if not properly closed or if not properly healed. The reasons could be wound infection, or excessive coughing, sneezing during the previous surgery.
Obesity is one of the major reasons for developing incisional hernias.

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Ventral hernia-

The umbilical, paraumbilical and incisional hernia come under this terminology.

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Hiatus hernia-

When the upper stomach leaves the abdomen and enters through the hiatus in the diaphragm in the thoracic cavity it is called a hiatus hernia.

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Causes of Hernia:



Weakness in the abdominal wall musculature or defect in the abdominal wall sheath or excessive intraabdominal pressure leading to hernia could be due to the following reasons:


  1. Obesity.

  2. Previous abdominal surgery.
  3. Failure of the umbilical defect to close at birth.
  4. Multiple pregnancies.
  5. Persistent coughing or sneezing.
  6. Lifting Heavyweights for long hours.
  7. Fluid in the abdominal cavity (ascites).
  8. Poor nutrition and smoking can also contribute to weakening the abdominal musculature.

Symptoms of a hernia:


  1. Heaviness or dragging sensation:Most of the hernias, initially present as if there is a pulling or dragging sensation or discomfort in the respective areas of the hernia eg groin. It draws attention to that area and a small swelling might be noticed.

  2. Swelling:This swelling may start as a small swelling, but may gradually increase in size. At first, in the initial months, the swelling will appear and disappear by itself, without you doing anything. But as days or years go by, the swelling might require pressure from outside to make it disappear ( reduce) into the abdominal cavity. This means that the hernia contents ( Omentum etc) has increased in size and is not able to reduce by itself. External pressure will help to reduce the contents back into the abdominal cavity.
  3.  Redusable hernia
  4. Pain: Normally, a hernia does not cause pain. If pain is present, this means that the contents are either getting stuck either to the hernia sac or to itself ( intestines getting stuck to one another), or the contents are getting strangulated (blood supply reducing ) and losing viability. This requires urgent medical attention and surgery.

Complications:


The complication of hernia is not uncommon if left untreated for a long time. The following are the complications:


  1. Obstruction: If the intestines in the hernia sac are not reducible and get obstructed, it may lead to severe pain and vomiting warranting immediate surgery.
  2.  Haital Hernia surgery
  3. Strangulation: Here, the blood supply to the intestines contained in the hernia sac is reduced or totally cut off. It could be due to a long-standing hernia left untreated due to adhesions to the hernial sac of hernia defect in between the intestines.
  4.  Haital Hernia surgery
  5. Ulceration : If neglected for a long time, the skin over the irreducible hernia thins out and finally ulcerates. This also needs to be attended to immediately as the infection might occur and spread.
  6.  Haital Hernia surgery
  7. Abscess: Infection in the omental contents of the irreducible hernia is also common. This happens because the omentum in the hernia keeps growing and becomes bigger than the neck of the sac(size of the defect). The blood supply decreases and an abscess forms. Surgery is required.

Diagnosis:



  1. Based on history narrated by the patient: Patients complains of swelling in the respective area as described above for eg: inguinal area, umbilical area (belly button) or at a previous scar site.

  2. Based on clinical examination: : Moment the surgeon examine whether the swelling is a hernia or not. On examination, an impuse will be felt by the palpating finger on coughing – termed as the cough impulse. It is diagnostic of a hernia, whether it be an umbilical inguinal or incisional hernia.

  3. Ultrasound scan of the abdomen : An ultrasound scan of the abdomen will reveal a defect in the abdominal wall and intestinal contents in the hernia sac if any at the time of the scan. A scan will also tell about the viability of the contents of the sac eg intestine.

  4. Upper GI endoscopy: This helps diagnose GERD, hiatus hernia.

  5. CT scan of the abdomen : This may be required in rare cases of complicated hernias or in extreme obesity to confirm the diagnosis of a hernia.

What is the treatment of hernia?



  • Non surgical :

    1. Truss
     Open surgery Hernia
     Open surgery Hernia


  • Surgical
  • This is the best and most sure treatment for a hernia. It was earlier done by the open technique, but now with the advance in technology, laparoscopic repair is the surgical treatment of choice for a hernia. All hernias can be treated by the laparoscopic technique.
    The advantage of laparoscopic repair is multiform, lesser hospital stay, less pain, cosmetic, early recovery 24 hours, early return to work

    1. Conventional (Open surgery)
    2.  Open surgery Hernia
       Open surgery Hernia
    3. Laparoscopic(Keyhole surgery)
    4.  Open surgery Hernia

      Laparoscopic Mesh repair of hernia

      Mesh is a must whether we chose the open or laparoscopic technique.

       Open surgery Hernia

    1. Types of hernia.

    2. Port placement of Laparoscopic Hernia Surgery.
    3. You can see that the port placement differs depending on the type of hernia that needs to be repaired. Also the size of the ports is 5mm( two ports) and 10mm ( one port)


    4. Types of Hernia Repair .

    5. TEP method of Hernia Repair .
    6. Inguinal hernia can be repaired laparoscopically by TEP method


    7. TAPP plug and patch repair.
    8. Inguinal hernia can be repaired laparoscopically by the TAPP method


    9. Bilateral Hernia by Totally extraperitoneal (TEP) repair Method.

    10. Direct indirect hernia.

    11. Multiple Hernias.

    12. Swiss cheese defects.
    13. Laparoscopic technique has a benefit over the open repair, in such case, where in we get a complete view from within and even if 2 to 4 defects are present , it will not be missed. In open technique this could be missed


    14. Recurrence of Hernia.
      1. Certain precautions should be taken so that hernia repair is good and does not recur.

      2. In the laparoscopic repair we use a larger mesh that covers and overlaps much beyond the edges of the hernia defects. This itself is a major contributing factor to avoid recurrence of a hernia.
      3. Don't lift heavy weights for 2 to 4 months post surgery
      4. Avoid anything that raises intra abdominal pressure like coughing, sneezing straining while passing stools etc
      5. Avoid lifting weights as the mesh will not stretch and one of the corners where it is fixed could snap leading to a recurrence.

      >Note : The surgeon will suggest the appropriate type of surgery based on the location and severity of your hernia.


    Meshes used in hernia repair



    1. Inguinal hernia .
    2.  3D mesh for inguinal hernia
       inguinal hernia plug and patch
    3. Umbilical hernia, Incisional hernia & Epigastric hernia .
    4.  symbotex for Umbilical hernia, Incisional hernia & Epigastric hernia
       parietec mesx for Umbilical hernia, Incisional hernia & Epigastric hernia
       symbotex for Umbilical hernia, Incisional hernia & Epigastric hernia

    What is the Cost of Hernia Surgery (in Bangalore)?


    The cost of Hernia surgery depends on many factors depending on Open/ Laparoscopic Surgery like


    1. Size of Hernia.
    2. Type of Hernia.
    3. Size of Mesh.
    4. Type of Mesh used.
    5. Fixation of Mesh.

  • >Note :For more details, please get a consultation done at our Hospital.
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    drtulip@todsindia.com

    8880537537

    +91 9845374457

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    Contact us


    Contact Info

    80 Feet Main Road, No.640, 12th Main Rd, 4th Block, Koramangala, Bengaluru, Karnataka 560034 India

    drtulip@todsindia.com

    8880537537

    +91 9845374457

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