Hernia

Inguinal Hernia

What is Inguinal Hernia ?

A hernia is a common condition in which part of an internal organ or tissue bulges through a muscle. An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the lower abdominal wall into the inguinal, or groin, area. There are 2 types of inguinal hernias:

1. Indirect inguinal hernias: This type of hernia is caused by a birth defect in the abdominal wall that is congenital (present at birth).
2. Direct inguinal hernias: This type of hernia usually occurs in adult males. These are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting

Hernias can be on one or both sides of the abdomen.

What is an incarcerated or strangulated inguinal hernia?

Incarceration or strangulation of inguinal hernias is rare, but serious complications can develop if a hernia is left untreated.

1. Incarcerated hernia: Incarceration occurs when part of the fat or intestine from inside the abdomen gets stuck in the groin or scrotum and cannot go back into the abdomen.
2. Strangulated hernia: Strangulation can occur when an incarcerated hernia is not treated. The blood supply to the intestine can be cut off, causing “strangulation” of the intestine. This is a very serious condition. You should seek immediate medical attention if you suspect you have an incarcerated or strangulated inguinal hernia.

Why does inguinal hernia occur ?

Some inguinal hernias have no apparent cause. Others might occur as a result of:

1. Increased pressure within the abdomen
2. A pre existing weak spot in the abdominal wall
3. Straining during bowel movements or urination
4. Strenuous activity
5. Pregnancy
6. Chronic coughing or sneezing

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs prior to birth when a weakness in the abdominal wall muscle doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.

In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place

Risk factors

Factors that contribute to developing an inguinal hernia include:

1. Being male. Men are eight times more likely to develop an inguinal hernia than are women.
2. Being older. Muscles weaken as you age.
3. Family history. You have a close relative, such as a parent or sibling, who has the condition.
4. Chronic cough, such as from smoking.
5. Chronic constipation. Constipation causes straining during bowel movements.
6. Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.
7. Premature birth and low birth weight. Inguinal hernias are more common in babies who are born prematurely or with a low birth weight.
8. Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you're at higher risk of developing another inguinal hernia.

What are the symptoms of inguinal hernia?

Inguinal hernias may be painless or cause no symptoms, especially when they first appear. Symptoms that can develop include:

1. A bulge on one or both sides of the groin that disappears when lying down.
2. Pain in the groin, especially when lifting, coughing or exercising.
3. A feeling of weakness, heaviness or burning in the groin.
4. A swollen scrotum (the sac-like a part of the male genitalia underneath the penis).

What are the lifestyle modifications to prevent inguinal hernias?

Although you can’t prevent genetic risk factors, it’s possible to reduce your risk of occurrence or the severity of abdominal hernias. Follow these tips:

1. Maintain a healthy weight.
2. Eat a high-fiber diet.
3. Quit smoking cigarettes.
4. Avoid heavy lifting.

Early surgical treatment can help cure inguinal hernias.

How is inguinal hernias treated?

Inguinal hernia repair is a common surgical procedure. Inguinal hernia surgery is also called herniorrhaphy or hernioplasty. There are 2 types of inguinal hernia repair:

1. Open hernia repair: A surgical procedure in which an incision, or cut, is made in the groin. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with mesh and stitches.
2. Minimally invasive or laparoscopic hernia repair: A less invasive surgical procedure in which the surgeon makes small, half-inch cuts in the lower abdomen and inserts a laparoscope (a thin tube with a tiny video camera attached). The laparoscope sends images to a video monitor and the surgeon to repairs the hernia through the small incisions.

Advantages of Laparoscopic Hernia Repair

1. Small incisions
2. Less pain
3. Shorter hospital stay
4. Early return to work

Incisional Hernia

What is Incisional Hernia ?

An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes. All abdominal surgeries carry a 33 percent risk of a postoperative incisional hernia, and approximately 33 percent of people undergoing abdominal surgery will experience an incisional hernia.

What are the types of incisional hernia?

Hernias are often categorized as reducible or irreducible:

1. Reducible hernias can be pushed back in. They may also shrink when you lie down.
2. Irreducible hernias happen when part of your intestine pushes into the hernia, making it hard to push the hernia back in.

Irreducible hernias can lead to bowel obstruction, which can then lead to a strangulated hernia. This requires immediate treatment..

Why does incisional hernia occur ?

Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision. An incisional hernia can occur for a number of specific reasons; individuals who participate in excessive or premature physical activity after surgery, gain considerable weight, become pregnant or increase abdominal pressure in any other way before the incision is fully healed are especially at risk for an incisional hernia. Incisional hernias are most likely to occur within three to six months post-surgery but can happen at any time.

Several risk factors can increase the chances of a hernia developing after surgery, including:

1. wound infection
2. existing health conditions, such as renal failure, diabetes, or lung disease
3. obesity
4. smoking
5. certain medications, including immunosuppressant drugs or steroids

You can help lower your risk for a hernia by taking the recommended amount of time to heal after abdominal surgery.

What are the symptoms of incisional hernia?

The most noticeable symptom of an incisional hernia is a bulge near the incision site. It’s often most visible when you strain your muscles, such as when you stand up, lift something, or cough.

Besides a visible bulge, incisional hernias might also cause:

1. nausea and vomiting
2. fever
3. burning or aching near the hernia
4. abdominal pain and discomfort, particularly around the hernia
5. faster heartbeat than usual
6. constipation
7. diarrhea
8. thin, narrow stool

What are the lifestyle modifications to prevent incisional hernias?

An incisional hernia develops after abdominal surgery, when an area of the intestine or other tissue pushes through the abdominal wall at or near the site of an incision.

It most commonly develops three to six months after abdominal surgery, when your abdomen is healing from the incision.

The following steps may reduce your risk of an incisional hernia after surgery:

1. Don’t overexert yourself.
2. Take steps to prevent and treat constipation to avoid straining.
3. Seek treatment for any persistent cough.
4. Try to limit the strain of sneezing, and get treated for any allergies.
5. Avoid any activities that put pressure on the area of your wound.
6. Quit smoking, to limit coughing.
7. Try not to gain weight.
8. Don’t become pregnant within six months of your surgery.

How is incisional hernia treated?

Hernias don’t go away on their own and are only treatable with surgery.

a. Small or reducible hernias

If you have a small or reducible hernia, you may be able to safely delay surgery. Your healthcare provider will consider your medical history and other factors when deciding if surgery will repair the hernia.

If your hernia causes little or no discomfort, it may be safe to watch the hernia and wait before having surgery. It’s important to note, though, that operations for larger hernias can be more difficult than operations for small hernias.

b. Large or irreducible hernias

If your hernia grows or becomes irreducible, you’ll need surgery. The recommended option will generally depend on your symptoms, the size of the hernia, and your medical history.

1. Open repair

Open hernia repair involves an incision at the hernia site. A surgeon will move tissue, intestine, and other organs forming the hernia back into the abdomen and close the opening.

They may also use mesh patches to reinforce the spot where the hernia developed. These mesh patches are sewn to the tissue around the hernia, where they’ll eventually be integrated into your abdominal wall.

1. Laparoscopic repair

Laparoscopic hernia repair involves multiple small cuts instead of one large cut. Hollow tubes are placed in these incisions, and air inflates your abdomen to make your organs more visible. A surgeon will then insert surgical tools, including a small camera, into the tubes to perform the surgery. Mesh may also be used in a laparoscopic repair.

Laparoscopic surgery is less invasive, and you may leave the hospital sooner and have a lower risk of infection, though it might not be as effective for very large or severe hernias.

Umbilical Hernia

What is Umbilical Hernia ?

An umbilical hernia is an unusual bulge that you can often see or feel over the belly button (the umbilicus). An umbilical hernia develops when part of the intestine, together with fat or fluid, forms a sac. This sac pushes through an opening in the muscle of the abdominal wall.

Why does umbilical hernia occur ?

Too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen include:

1. Obesity
2. Multiple pregnancies
3. Fluid in the abdominal cavity
4. Previous abdominal surgery
5. Long-term peritoneal dialysis to treat kidney failure

Risk factors

Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. The condition affects boys and girls equally.

For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia tends to be more common in women.

Complications

For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to abdominal pain and tissue damage.

Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines. Emergency surgery is typically required to treat these complications.

What are the symptoms of umbilical hernia?

Umbilical hernias can usually be seen when your baby is crying, laughing, or straining to use the bathroom. The telltale symptom is a swelling or bulge near the umbilical area. This symptom may not be present when your baby is relaxed. Most umbilical hernias are painless in children.

Adults can get umbilical hernias as well. The main symptom is the same — a swelling or bulge near the navel area. However, umbilical hernias can cause discomfort and be very painful in adults. Surgical treatment usually is required.

How is umbilical hernias treated?

The only way to repair an umbilical hernia is through surgery. An umbilical hernia repair surgery helps to push the sac back into place and strengthen the abdominal wall. There are two types of surgery available to repair the hernia.

1. a. Open hernia repair In this surgery, make a small incision near your hernia and a surgical mesh is placed over the hernia site in the muscle. The mesh reinforces the area to help prevent the hernia from coming back.
2. b. Laparoscopic hernia repair This type of surgery uses mesh or sutures to repair the hernia. The mesh or sutures are placed using instruments that go through small incisions in your abdomen.

What happens if Umbilical hernia is not treated by surgery?

Without repair, your hernia can continue to grow and become more painful over time. The risk of the sac becoming incarcerated or strangulated goes up the longer your umbilical hernia goes untreated.

Femoral hernia

What is Femoral Hernia

A femoral hernia is fairly uncommon and is most commonly found in women. Femoral hernias are found in the groin region and can appear as a painful lump on the inner, upper thigh. The lump can be pushed back in and can sometimes become more prominent when straining or coughing. They are more common in women because women have a wider pelvis.

Why does Femoral Hernias occur?

The exact cause of femoral hernias are unknown most of the time. You may be born with a weakened area of the femoral canal, or the area may become weak over time.

Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:

1. childbirth
2. chronic constipation
3. heavy lifting
4. being overweight
5. difficult urination due to an enlarged prostate
6. chronic coughing

What are the symptoms of Femoral Hernia?

Small and moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.

Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Femoral hernias are often located very close to the hip bone and as a result may cause hip pain.

Severe symptoms of a femoral hernia

Severe symptoms can signify that a femoral hernia is obstructing your intestines. This is a very serious condition called strangulation. Strangulation causes intestinal or bowel tissue to die, which can put your life in danger. This is considered a medical emergency. Severe symptoms of a femoral hernia include:

1. severe stomach pain
2. sudden groin pain
3. nausea
4. vomiting

How is Femoral Hernia treated?

Hernias often get larger as time passes. They do not go away on their own. Compared to other types of hernias, femoral hernias more commonly have small intestine get stuck in the weak area. Surgery is recommended to avoid a possible medical emergency.

Femoral hernia repair can be done as either an open or laparoscopic surgery. An open procedure requires a larger incision and a longer recovery period. Laparoscopic surgery uses three to four keyhole-sized incisions that minimize loss of blood.

Hiatal Hernia

What is Hiatal Hernia?

A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm).

Your diaphragm has a small opening (hiatus) through which your food tube (esophagus) passes before connecting to your stomach. In a hiatal hernia, the stomach pushes up through that opening and into your chest.

What are the causes of Hiatal Hernia?

The exact cause of many hiatal hernias isn’t known. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm.

Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:

1. coughing
2. vomiting
3. straining during bowel movements
4. lifting heavy objects

Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it.

Factors that can increase your risk of a hiatal hernia include:

1. obesity
2. aging
3. smoking

What are symptoms of Hiatal Hernia?

Symptoms

Most small hiatal hernias cause no signs or symptoms. But larger hiatal hernias can cause:

1. Heartburn
2. Regurgitation of food or liquids into the mouth
3. Backflow of stomach acid into the esophagus (acid reflux)
4. Difficulty swallowing
5. Chest or abdominal pain
6. Feeling full soon after you eat
7. Shortness of breath
8. Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding

What is the treatment for Hiatal Hernia?

Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.

Medications

1. Antacids that neutralize stomach acid.
2. Medications to reduce acid production.
3. Medications that block acid production and heal the esophagus.

When is surgery for a Hiatal Hernia needed?

If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

1. Pulling the hiatal hernia back into the abdomen.
2. Improving the valve at the bottom of the esophagus.
3. Closing the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.

Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:

Smaller incisions.

Less risk of infection.

Less pain and scarring.

A shorter recovery.

What are the lifestyle modifications to control the symptoms and signs caused by a hiatal hernia?

Acid reflux causes most hiatal hernia symptoms. Changing your diet can reduce your symptoms. It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.

There are also certain foods that may increase your risk of heartburn. Consider avoiding:

1. spicy foods
2. chocolate
3. foods made with tomatoes
4. caffeine
5. onions
6. citrus fruits

alcohol

Other ways to reduce your symptoms include:

1. stopping smoking
2. raising the head of your bed by at least 6 inches
3. avoiding bending over or lying down after eating

Diaphragmatic Hernia

What is Diaphragmatic Hernia?

The diaphragm is a muscular sheet that separates the lungs from the contents of the abdomen. The main function of this sheet is to help in respiration. Just like the plunger in a syringe, the diaphragm moves down during breathing and creates a negative suction pressure in the chest. This action sucks the air from the atmosphere into the lungs.

Due to various reasons, this muscular sheet can have a defect or a hole. Through this hole, the contents of the abdominal cavity can migrate up into the chest and lie there. This causes compression of the lungs on that side, thereby preventing its effective expansion and breathing. This condition is referred to as a diaphragmatic hernia.

What are the Causes of Diaphragmatic Hernia?

A diaphragmatic hernia is an uncommon condition. Most commonly, the defect occurs because of a developmental problem when the child is in the womb of the mother. The children are born with this defect. Many times, this is diagnosed immediately after birth when the hernia is large, and the child develops breathing difficulty. Sometimes this problem can go unnoticed till adulthood when it is diagnosed by an X-ray done routinely for some other problem.

This problem can also arise due to other reasons like trauma, obesity and as a result of some surgeries.

What are the Symptoms of Diaphragmatic Hernia?

The most common symptom is difficulty in breathing. This can occur during rest when the hernia is very big. In moderate size hernias the patient might experience breathing difficulty during exertion like running or climbing stairs. Babies born with large hernia can have severe breathing problems after birth and may be needed to be kept on artificial breathing support on a ventilator.

Sometimes when the intestines which have migrated into the chest can get twisted and this can cause intestinal obstruction causing vomiting and inability to pass stools. This is a serious life threatening emergency.

What are the Complications of Diaphragmatic Hernia?

When there is a defect or hole in the diaphragm, the respiratory movement is not very effective. And through this hole the intestines can start slowly migrating up from the tummy into the chest.

As more and more intestines move into the chest cavity. The lungs in the chest does not have enough space to expand because the chest cavity gets occupied with intestines gradually.

This is the reason that the diaphragmatic hernia generally presents with respiratory complications. Patients come with breathlessness complaining about gradually increasing difficulty in breathing. And when we do a scan or X ray we find a large diaphragmatic hernia.

Types of Diaphragmatic Hernia

There are two types of diaphragmatic hernia, one is Congenital diaphragmatic hernia and the second is acquired diaphragmatic hernia.

1. Congenital Hernia Congenital meaning by birth there is an incomplete formation diaphragm. Therefore, there is a defect in that and the intestines are already present in the chest and it needs to be repaired early.
2. Acquired Hernia Acquired diaphragmatic hernia develops during the course of life. Through this defect intestines migrate into chest cavity over time.

How is Diaphragmatic Hernia Treated?

Small diaphragmatic hernias which don’t cause any symptoms do not require any treatment. Large symptomatic hernias need repair. In most cases this repair is done laparoscopically. A mesh is usually placed to cover the defect and the hernia is repaired. The recovery time after laparoscopic hernia repair is usually very short and patients are back to their normal activities in a week.

Laparoscopic Surgery for Diaphragmatic Hernia

Like any other hernia medical treatment does not work for diaphragmatic hernia. The treatment has to be surgical.

With the advent of laparoscopic techniques, the treatment is much simpler these days. The patient undergoes a laparoscopic not a keyhole operation during which the hole in the diaphragm is sutured and it is reinforced with a composite dual layered mesh and thereby a future recurrence of hernia is prevented. The recovery time is very fast. Generally diaphragmatic hernia repair patients go back from the hospital within a day or two and within a week they are able to resume all their normal daily activities.