Category : Healthcare
What is hernia?
Hernia is abnormal protrusion (bulge) of abdominal contents (viscera) through a weakened part of abdominal wall.
What is the nature of hernia?
A hernia does not get better over time, nor will it go away by itself. It always becomes bigger with time. It may undergo complications. So, it has to be treated. Most of the cases surgery is the only treatment option
What are the common types?
The common sites of hernia are groin (inguinal and femoral), belly button (umbilical) and at the site of previous surgery (incisional). There are many more types but are not common.
Who are at risk of getting hernia?
Anyone can get hernia, from Newborn to Elderly persons. At risk are Persons engaged in hard labour like lifting heavy goods, with chronic cough, straining for passing urine and stools, smokers, obese persons with previous open abdominal surgeries are common to get hernia.
How will patient with hernia comes to the doctor?
Initially hernia is usually presenting as a bulge under the skin especially on standing or working straining and disappears on lying down. Pain may or may not be present with the bulge. Few cases present as emergency if the bulge is not reducing, associated with pain and vomiting, not passing stools (Strangulation/ Obstruction). In such case patient should visit the surgeon as soon as possible.
How to detect or diagnose hernia?
A doctor can detect by examining the patient.
What are the investigations needed to confirm the diagnosis?
No investigations are needed to confirm the diagnosis. Ultrasound scan, sometimes CT scan is required for diagnosing very small hernias and in obese patients.
When to take treatment?
As early as possible to prevent complications like obstruction and strangulation.
What is the treatment for hernia?
Surgery is the only treatment for hernia. No medicine will cure it.
What are the Complications of hernia if not treated?
Can increase in size causing discomfort or dragging pain in the lower abdomen. Can become irreducible. Can lead to obstruction/strangulation of the intestines – where hernia requires emergency surgery.
What is the surgical treatment?
Surgical procedure differs depending on the age, associated medical diseases and the mode of presentation (symptoms).
There are 3 commonly done surgical procedures
- Herniotomy – In new-born babies, infants, children
- Herniorrhaphy – in selective cases
- Hernioplasty – Gold standard for hernias in adults
The above-mentioned surgeries can be done as Open surgery or minimally invasive surgery/ laparoscopic surgery. Minimally invasive surgery is otherwise called as Keyhole surgery
There are 2 variants in keyhole approach – TAPP & TEP.
TAPP – Transabdominal Pre-Peritoneal Approach
TEP – Total Extraperitoneal Approach
Depending on your clinical presentation, age, associated disorders, the surgeon will counsel about the surgical procedure and the approach that is apt for you
Open vs laparoscopic approach – which is better?
Both have advantages & disadvantages. As previously mentioned, the approach to surgery will be explained by the surgeon based on different clinical parameters
What are the advantages of Laparoscopic surgery for hernia over the conventional open surgery?
Compared to open surgery, laparoscopic approach have some advantages:
- Much less pain.
- Patients will be able to walk within few hours of surgery – early mobilisation.
- Patients will be discharged early from hospital within one or two days after surgery – sometimes can be done as Day Care Surgery.
- Patients are allowed to resume routine activities early (within 5-7 days).
- Both sides of inguinal hernia can be operated with the same three incisions.
- Cosmetic results are excellent.
Is it necessary to use MESH in the repair of all hernias?
Yes. It is standard principle that MESH should be applied in the repair of hernia in majority of patients to strengthen the defect whether the surgery is done by open or Laparoscopic method. Only in children hernias are repaired without using MESH.
Is it safe to undergo Laparoscopic repair for hernia?
Yes. If done by a properly trained surgeon in a well- equipped centre it is a safe surgery with excellent results.
What are the conditions where open approach is preferred than a laparoscopic surgery?
Open approach is preferred than a laparoscopic surgery? if:
- If the hernia is very large in size
- If a patient can’t receive general anaesthesia
- If a patient had multiple complicated abdominal surgeries
What are the complications of surgery?
The complications of hernia surgery are:
- Seroma- collection of tissue fluid in the wound (commonest complication).
- Hematoma- collection of blood in the wound.
- Mesh infection- most dreaded complication. Requires removal of mesh, thorough washing of wound and culture-based antibiotics
- Pain at operative site. Usually subsides with normal pain killers.
What is the hospital admission procedure?
Once the disease diagnosis is confirmed, baseline investigations will be done. If the results are normal, then patient will be admitted in the hospital. After getting preoperative anaesthetic evaluation, patient will be operated. After surgery, patient will be kept in post-operative ward for a couple of hours to assess the recovery from anaesthesia and later shifted to
What is the length of stay in hospital?
Hospital stay following laparoscopic hernia surgery is less as compared to open surgery.
Laparoscopic hernia surgery – 1 to 2 days for all hernias
Open hernia surgery – 3 or more as per type of hernia
What precautions we have to take after undergoing hernia surgery?
- Should not lift weight for 3 months.
- Should stop smoking.
- Should lose weight if obese.
Should have regular follow up if a person is suffering from chronic cough or has straining while passing urine or stools should take treatment for the condition.