A hernia is a general term that refers to a protrusion of a body tissue through a wall of a cavity in which it is normally contained.
An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall.
When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs)
Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.
Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a Hernia including
• Heavy weight lifting
• Straining during bowel movement or urination
• Fluid in the abdominal cavity
• Chronic lung disease
Symptoms of a hernia include pain or discomfort and a localized swelling on the surface of the abdomen or in the groin area.
A hernia can also be painless and only appear as a bulging.
The pain may be intermittent or constant and the swelling may decrease or be absent, depending on the amount of pressure in the abdomen.
Constant, intense pain at a swollen site may be a surgical emergency and should be consulted to Surgeon immediately.
Hernia makes up 75% of all abdominal wall hernias and occurs 25 times more often in men than women.It can affect people of all ages. Umbilical Hernia is a protusion at the bellybutton,caused when the opening in the naval ,which normally closes before birth ,doesn’t close completely.Even if the area is closed at birth, Umbilical hernia can appear later in life because this spot may remain a weaker place in the abdominal wall. Incisional Hernia occurs after 2-10% of all abdominal surgeries as the surgery tends to create an area of weakness in the abdominal wall. Femoral,Epigastric,Spigelian and Obturator are very rare types of hernias.
Epigastric,Umbilical and Incisional Hernias are collectively called as Ventral Hernia.
Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows.
The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime.
In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.
Under certain circumstances the hernia may be watched and followed closely by a physician. These situations are unique to those individuals who are at high operative risks (i.e. those with severe heart or lung disease, or bleeding problems).
Of course, even in the high risk person, if the symptoms become severe or if strangulation occurs, then an operation must be performed.
Serious complications from a hernia can result from the trapping of contents in the hernia — a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to strangulation resulting in gangrene or death of the content,usually small bowel . This warrants Emergency Surgery
There is no acceptable nonsurgical medical treatment for a hernia. The use of a truss (hernia belt) can help keep the hernia from bulging but eventually will fail. The hernia will not go away without treatment; it will only get bigger.
The bigger the defect the bigger the operation required to fix it.
There are two main options for hernia repair:
1. Open Repair: The traditional, open repair has been the gold standard for over 100 years. There are 5-10 different approaches that are performed routinely with local and intravenous sedation. Due to the larger size of the incision, open hernia repair is generally painful with a relatively long recovery period.
2.Minimally Invasive (Laparoscopic,Key hole surgery) Repair: Minimally Invasive (Laparoscopic) Repair has been developed over the past decade. It is usually performed under general anesthesia but Epidural anaesthesia is also an option.
There are two approaches in Laparoscopic Repair-TAPP(Transabdominal Preperitoneal) and TEP(Totally Extraperitoneal).In both the approaches the Mesh is placed in the preperitoneal space.
In laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient’s belly button. Two other small cuts are made (each no larger than the diameter of pencil eraser) in the lower abdomen. The hernia defect is reinforced with a ‘mesh’ (synthetic material made from the same material that stitches are made from) and secured in position with stitches/staples/titanium tacks or tissue glue, depending on the preference of your individual surgeon.
- Less hospitalisation
- Less bleeding
- Less pain
- LESS IS MORE- “COSMETIC”
Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or have underlying medical conditions.
Laparoscopic is the procedure of choice for hernias that are recurred after Open Hernia Repair
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
- There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
- Difficulty urinating after surgery is not unusual and may require a temporary tube into the urinary bladder.
- Any time a hernia is repaired it can come back.The incidence of recurrence is almost nil when performed by trained surgeons as reported world wide.
We perform Laparoscopic Hernia Repairs as a DAY CARE procedure. Patients are admitted the same day of their surgery. Following the procedure and recovery from anesthesia, they are taken to a hospital room where they spend the night. We encourage our patients to move as quickly as possible. Most patients stay in the hospital 1 or 2 days following surgery. Patients are then seen, by the surgeon, one week after discharge.
There is no dietary restriction.
Activity level is restricted by the patient’s comfort level.
However, it is generally not advisable to engage in any strenuous exercise or heavy lifting for few weeks , to allow the hernia repair to heal.