WHAT IS A HERNIA ?
A hernia usually happens in your abdomen or groin, when one of your organs pushes through the muscle or tissue that contains it. It may look like an odd bulge that comes and goes during different activities or in different positions. A hernia occurs when a weakness or a preexisting opening in your muscle or connective tissue allows the internal organ or other tissue to push through the barrier. Sometimes the weakness or opening is present at birth, but usually, it develops during your lifetime. A traumatic injury or surgery could cause it, but more often, it’s a repetitive stress injury. Years of pressure or exertion can wear the tissue down.
You may not feel it at all, or you may feel pressure, a dull ache or a sharp pain when the hernia comes through the opening. If you have frequent discomfort, you should see the surgeon near you right away.
WHAT ARE THE RISK FACTORS:
You may be more likely to acquire a hernia if you have:
* A job that involves heavy lifting or many hours of standing.
* Chronic cough or allergies that cause chronic sneezing.
* Chronic constipation and straining to poop or pee.
* A history of abdominal or pelvic surgery.
* Pregnancy, especially repeat pregnancies.
* Chronic obesity (a body mass index, or BMI, greater than 30).
WHAT ARE THE DIFFERENT TYPES OF HERNIAS:
1) Inguinal hernia: The most common type, accounting for 75% of all hernias. They mostly affect men. They happen when part of your bowel protrudes into your inguinal canal, a passageway that runs down your inner thigh.
2) Femoral hernia: Less-common type of groin hernia that occurs in the femoral canal, which runs underneath the inguinal canal. Fatty tissue may poke through.
3) Hiatal hernia: Another common type of hernia that you acquire during your lifetime. It happens when the opening in your diaphragm — where your esophagus passes through — widens, and the top of your stomach pushes up through the opening into your chest.
4) Incisional hernia: It occurs when tissue protrudes through a former incision in your abdominal wall that weakened over time. It’s a common side effect of abdominal surgery.
5) Umbilical hernia: It occurs when part of your intestine pokes through an opening in your abdominal wall near the umbilicus. Most umbilical hernias are congenital (present from birth).
6) Ventral hernia: A hernia that occurs through the front wall of your abdomen. It includes umbilical hernias and incisional hernias. An “epigastric hernia” is a ventral hernia above the belly button.
WHAT SYMPTOMS WILL I HAVE ?
1) Visible lump or Bulge that appears during certain activities or in certain physical positions and goes back in at other times is the commonest presentation.
2)You may also feel pressure, a dull ache or pinching when the hernia comes out. It may come out when you’re straining, lifting, laughing or coughing.
DIAGNOSIS AND TESTS:
A simple physical exam is often enough to diagnose a hernia, depending on the type. The Doctor may be able to see or feel it, or it may emerge when they ask you to cough or adjust your position. They’ll check to see if they can physically reduce it — make it go back in — to determine how serious it is.
Some hernias may require a form of soft tissue imaging, such as a CT scan to diagnose.
DO ALL HERNIAS NEED SURGERY?
If you have a small and reducible hernia, that means, it goes in easily , then you may not need a surgery. In such cases you have to avoid all factors which increase the abdominal pressure( Avoid Lifting heavy weights, prevent and treat cough, prevent constipation and reduce weight) that can gradually increase the hernia size and eventually need a surgery.
But if the hernia is big, the possibility of complications are higher and so the surgeon may advice you a Hernia Repair Surgery.
A hernia becomes serious when it gets stuck in the hole that it’s pushed through and can’t go back in. This can become painful, and in severe cases the tissue can become cut off from blood supply, causing necrosis (tissue death). Since hernias tend to worsen over time, most will need surgical repair sooner or later. You might need an emergency surgery when:
- A hernia bulge that is suddenly larger than before
- A hernia bulge that used to go back inside the abdomen but no longer does
- Fever
- Redness in the area of the hernia
- Sudden or severe pain or tenderness in the area of the hernia
- Symptoms of intestinal obstruction, such as abdominal pain, bloating, nausea, and vomiting
SURGERY FOR HERNIA REPAIR:
Hernia repair surgery is common and generally a minor procedure unless there are complications. The surgeon will push the herniated tissue back into place and reinforce the barrier it pushed through with stitches or with surgical mesh. Hernia Repair surgery can be done by a Traditional Open method, which is still the best in many cases. However, Laparoscopic and minimally Invasive Hernia repair and Even Robotic surgery is done for Hernia Repair Surgery. A MESH is commonly used to repair the defect in the abdominal wall and give it strength., thus preventing further recurrences.
WHAT TYPE OF ANAESTHESIA IS GIVEN FOR HERNIA SURGERY?
- Local Anaesthesia with Sedation
- Spinal Anaesthesia with or without sedation
- Nerve Block with Sedation: In patients who have severe heart disease or lung disease.
- General Anaesthesia: For Laparoscopic repair or when there are complications like Intestinal gangrene.
ANY PRECAUTIONS TO BE TAKEN POSTOPERATIVELY?
Early/ Immediate Mobilization post surgery is advisable. Usually, avoid constipation, cough and lifting weights is advised to prevent recurrence. Mild pain or irritation may be there for some patients in the postoperative period , which can be managed by oral medicines.
DR SACHIN WANI (MBBS, MS, DNB GI Surgery,Fellowship in Lap HPB Surgery ,Southampton,U.K.)
Surgical Gastroenterologist, Specialist in Complex G.I & Hepatobiliary Surgery .
HealWell Speciality Clinic , S1-24, Dosti Imperia, Manpada, Ghodbunder road, Thane West.
FOR APPOINTMENTS CALL/WHATSAPP: 8169104438.