WHAT IS A HERNIA ?

A hernia is a weakness or opening in the abdominal wall, that often results in bulging out of fat or an organ such as intestine, which then occupies space under the skin.

The opening in the abdominal wall through which the fat or organs protrude is called the Hernia defect.

Hernia can affect anybody – going by statistics one-in-ten of us will have hernia at some point in our lives. It is found in both sexes, can occur at any age and sometimes infants may be born with it.

Surgery for hernia is one of the most commonly performed operations worldwide with millions of cases being treated every year.

Treatment of Hernia

The definitive treatment of hernia is a surgery. With a lot of hernias remaining asymptomatic for long, an obvious question that can arise in one's mind is, ' What if I leave my hernia untreated?' Well, the general consensus within the medical fraternity is that 'All hernias should be repaired unless severe pre-existing medical conditions make surgery unsafe'. Many patients, especially those having a smaller, asymptomatic hernia who are anxious of undergoing a surgery still choose to stay away from a surgical treatment. However it should be borne in mind that : An asymptomatic hernia usually causes pain and discomfort with time. Also, in those with mild existing symptoms, the symptoms usually worsen with time.

In case you delay a surgical treatment, the hernia will most likely increase with time, making a future repair technically more difficult.

The earlier the repair, the smaller the hernia and the lesser the trauma from surgery. Typically, a more rapid recovery is achieved after surgery for a smaller hernia.

The possibility of strangulation always looms large. It is usually more common with the smaller hernias and you certainly do not want it while you are on a vacation in some remote place or before an important event like a wedding. Patient Testimonials

Thus, a wise decision would be to find a hernia specialist and get the hernia repaired as soon as possible. A useful rule of thumb is that once you are sure you have a hernia, it is best to have it treated as early as possible and as well as possible.

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UNDERSTANDING THE BASICS OF A HERNIA SURGERY



The goal of a hernia surgery is to repair the weak tissue in the abdominal wall and seal the defect so that fat or intestines cannot push through it again. Depending upon the surgical approach used, there are two types of repairs; Open repair and Laparoscopic ( keyhole ) repair. In an Open surgery, a single long incision ( cut ) is made in the area of the hernia. The herniated organs are pushed back in place and the area is then sutured back with/without placing a mesh to strengthen the weak area of the abdomen. The basic principles of a Laparoscopic repair remain the same, the only significant difference being that instead of a single long cut, several small ( 3-5 ) nicks are made each being about a centimetre long. A laparoscopic repair is done under general anaesthesia and carries more benefits like a quicker recovery, lesser post-operative pain and lower infection rate. However, a laparoscopic repair may not be possible if you have a large hernia or you can't receive general anaesthesia. It is best to leave the decision to your doctor who will be in a better position to decide which approach would benefit you more depending upon various factors like location/type/severity of hernia as well as your medical history.

I. INGUINAL HERNIA REPAIR SURGERY



Primary Muscular Repair aka Shouldice's Repair

This method involves pushing back the herniated organs and sewing the abdominal wall tissues back together with the help of sutures. However, the abdominal muscles are constantly under tension after the suturing and hence may potentially give way once again in the future. Hence, this procedure has a high recurrence rate. Simple Prolene Mesh Repair aka Leichenstein's Repair

In this 'tension-free' repair, a Polypropylene mesh is used to seal the defect so that the tension that the muscles are under in a Shouldice's repair is avoided. The procedure is usually done under local anaesthesia and needs 24-48 hour hospitalisation. Although the procedure is time tested, safe and economical, there are chances of post-operative groin pain ( Inguinodynia ) due to nerve entrapment. Laparoscopic Repair ( TEP and TAPP Repair )

In these procedures done under general anaesthesia, a Polypropylene mesh is placed on the inner side of the abdominal wall ( posterior compartment ). However, these are technically much more difficult procedures with a recurrence rate of 8-15%. Hospitalisation time needed is 24-48 hours. 3-D Mesh Hernia Repair

This is the most advanced and preferred technique for inguinal hernia repair. It is a simple and promising method which covers the hernia defect from 3 sides- above, below and centre. It is a tension-free repair in which a Polypropylene mesh is used.



Advantages Negligible recurrence rate

No risk of chronic groin pain as no stitches are taken to fix the mesh.

It is a very short procedure requiring about 15-20 minutes

Day care procedure with a short hospital stay of about 12 hours.

HEALING HANDS CLINIC HAS BEENRECOGNISED AS CENTRE OF EXCELLENCE FOR 3D MESH HERNIA REPAIR BY DR. JOHN MURPHY, EX-PRESIDENT - AMERICAN HERNIA SOCIETY

II. FEMORAL HERNIA REPAIR SURGERY



A Femoral hernia repair surgery can be done either as an open surgery or a laparoscopic ( keyhole ) surgery. In the open surgery a single long incision/cut is made whereas in a laparoscopic surgery about 3 small nicks are made. In either of the surgeries, the surgeon reduces the hernia by pushing the fatty tissues/loop of bowel back into the abdomen. This is followed by securing the femoral canal with a mesh to repair the weak spot which let the hernia through.

Both open and keyhole surgeries are safe and effective, although there is lesser pain and a faster recovery after a keyhole surgery. The choice of which technique to use depends upon your general health and the expertise of the operating surgeon.

III. UMBILICAL HERNIA REPAIR SURGERY



Umbilical hernia in adults is becoming fairly common due to increasing incidence of obesity and laparoscopy ( Port-site hernia ). A repair may be done in either if the following ways:

Primary Muscular Repair

This method involves reducing the hernia and sewing the abdominal muscles back together with the help of sutures ( surgical thread ). However, this method has a high recurrence rate due to absence of mesh.



Prolene Mesh Repair

In this method, a Polypropylene mesh is placed over the defect. However, following this procedure, there are high chances of collection of pus at the operation site which makes it an unfavourable choice.



Laparoscopic Repair

Done under general anaesthesia, 4 incisions of 1 cm each are taken. The defect is closed from the posterior aspect with a mesh. Although quite popular because of less post-operative pain and early recovery, the cosmetic outcome of this procedure is not good as some amount of bulge remains post-operatively.



3-D Mesh repair

Most of the above methods involve removing the umbilicus, but at Healing Hands Clinic we ensure that umbilicus is preserved by adopting a modified 3-D umbilical hernia repair. In this procedure, the defect is closed from the anterior as well as posterior aspect. The umbilicus is repositioned to achieve an excellent cosmetic outcome. It is a day care procedure which means you will be discharged from the hospital the same day. The recurrence rate is almost negligible.

IV. EPIGASTRIC AND INCISIONAL HERNIA REPAIR



Umbilical hernia in adults is becoming fairly common due to increasing incidence of obesity and laparoscopy ( Port-site hernia ). A repair may be done in either if the following ways: