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Q. What is a Hernia ?
Hernia is nothing but a weakness or a tear in the abdominal muscles which allows fatty tissue or an organ such as the intestines to protrude through the weak area. This can cause a noticeable buldge under the skin, and the pressure of tissue pushing its way through the weakened area, can be the cause for Considerable pain and discomfort.

    Symptoms can feel worse
  • When standing for long periods
  • During urination
  • During bowel movement or
  • When lifting heavy objects or
    In other words when anything puts additional strain on the area.

EVEN IF U THINK U HAVE A HERINA, CONSULT YOUR SURGEON. SO THAT SERIOUS COMPLICATIONS CAN BE AVOIDED

Q. Is having Hernia Dangerous?
Well, this depends on how the "BULGE" behaves. If the bulge flattens out when you lie down or push against it, you have what is termed as REDUCIBLE HERNIA - In this case you are not in immediate danger but nevertheless this should be evaluated by your Surgeon.

If the contents coming out through the hernia never flattens out and is stuck, then you have what is know as NON REDUCIBLE HERNIA - This case is often painful and may also indicate that part of the intestine is very tightly trapped - What is called as STRANGULATED HERNIA - Which is DANGEROUS AND MAY BECOME LIFE THREATENING as the intestinal blood supply may have been blocked or cut off and that part of intestines may die & become gangrenous.

    Symptoms of Blockage include
  • Blood in stool
  • Fever
  • Constipation
  • Severe pain
  • Vomiting and even
  • Shock

This condition is considered on EMERGENCY and immediate surgery will be needed to remove the blockage and to repair the hernia.

Q. What causes a Hernia ?
Despite the common belief that heavy lifting is the cause of the occurence of the hernias, the reality is that most hernias are the result of the defect or weakness that exists long before the hernia appears. OFTEN THE WEAKNESS IN THE ABDOMINAL WALL IS PRESENT AT BIRTH.

The area can also be weakened by age, injury or a previous surgical operation. However lifting of heavy weights, or other strenuous activities can also aggravate the hernias.

    Hernias can develop in either sex, more common in men than women, RISK FACTORS which can put additional strain on the abdominal wall and aggravate the hernia include,
  • Chronic Cough due to either respiratory disorders or due to smokers cough.
  • Overweight / obesity.
  • Straining during bowel movements - due to constipation or while urinating - due to enlarged prostate.
  • Pregnancy
  • Straining to lift heavy objects etc.

Q. Are HERNIAS of different types ?
Hernias are Categorized by their location in the abdominal wall / groins.
Some of the common Hernias include

INGUINAL HERNIAS: This is the most common type of hernia. As this occurs through the internal ring, a potentially weak spot in groin through which also the testicles in males descend during foetal development, this hernia is more common in males.

Indirect inguinal hernia occurs when defect is at the internal ring. From here the hernial sac may extend into the scrotum in males or to the outer folds of the vagina in females.

A direct inguinal hernia usually occurs in elderly people and it occurs near the internal ring . It OCCURS AS BILATERAL BULGES in lower abdomen near root of penis. Groin hernias is perhaps the commonest surgical operation performed by a general surgeon. Failures or recurrence of hernia after surgery is 2-5%. Such recurrent groin hernias have to be re-operated. This is often far more difficult & needs expertise of an experienced surgeon & possibly one has to use mesh to get a successful result.

EPIGASTRIC HERNIAS: Bulge appears above the naval, in the upper middle area of the abdomen, and is commoner in men.

INCISIONAL HERNIAS: This type of hernia can develop after weeks, months or even years after initial surgery at the site of the previous surgical incision.

FEMORAL HERNIAS: This mostly affects women and the swelling appears below and lateral to an anatomical landmark in the body known as public tubercle ie. The hernia appears below the groin crease.

OTHER HERNIAS: Other hernias generally tend to occur in the midline of the abdomen either in and around the umbilicus or at other weak points like sites of previous abdominal surgery like caesarian section, hysterectomy, puerperal sterilization or tubectomy, open appendicectomy, open cholecystectomy or any other operation including laparoscopic 10 mm port sites. Some of these hernias also called collectively as 'VENTRAL HERNIAS' can assume massive proportion, if neglected for a long time. Usually these massive ventral hernias often become complicated, like irreducibility , obstruction or even the life threatening complication of strangulation. Some of these patients, mostly women, have other medical problems like obesity, diabetes, high B.P., asthma or heart disease. Successful surgery without major complications in these patients is highly challenging even in the hands of highly skilled and experienced surgeons. If emergency surgery is needed for any complication, results of surgery may not always be successful. But planned surgery after proper evaluation and control of associated diseases like B.P., diabetes, Heart disease etc. gives the best results.

Q. What to do when i have a HERNIA ?
Even if the bulge is not causing you any problems it is very important you see your surgeon who will advise you properly. A hernia WILL NOT go away on its own. And left untreated, hernias can develop SEVERE-even life-threatening complications.

SURGERY IS THE ONLY CURE FOR HERNIA. In fact hernia repair is one of the most common surgical procedures done.

As with any surgery some risk is involved with hernia operation. But, with the latest technique of surgeries available for hernia repair the risks and discomforts following operation are minimal.

SURGICAL TECHNIQUES AVAILABLE FOR HERNIAS IN CHILDREN - After dissection & separation of hernial sac ligation & excision of hernial sac (HERNIOTOMY) and closing the inguinal region in layers is all that is required.

FOR INGUINAL HERNIAS IN OLDER INDIVIDUALS: HERNIOTOMY + repair of the weakened Posterior wall by approximating conjoint tendon to inguinal ligament using prolene sutures interrupted (HERNIORAPPHY) taking a first good bite in the public tubercele followed by double breasting external oblique and closing inguinal region in layers is required. In patients where posterior wall is weak , Herniotomy + placing a prolene Mesh trimmed to proper size & anchored between conjoint tendon and inguinal ligament using interrupted prolene Sutures (HERNIOPLASTY) is done.

LAPAROSCOPIC REPAIR: With introduction of Laparoscopy. A POSTERIOR HERNIA REPAIR has been made possible. The Laparoscope, a thin instrument consisting of a lighted tube with magnifying lenses to which camera is attached is inserted through a small incision in the abdomen. The Laparoscope enables surgeon to examine hernia & place a mesh patch on the INSIDE OF ABDOMINAL WALL and not outside as with traditional mesh repair. Laparoscopic Hernia repair however has DISADVANTAGES. - One of the biggest disadvantage being that General Anesthesia is required for the surgery - Secondly it is also 3-4 times Costlier than standard Hernia repair and Finally the recurrence following this technique & long term follow up of this technique have to be proved.

Q. How to get prepared for a HERNIA operation ?

    Learn all you can about hernia.
    Talk to your Surgeon
  • Ask him to explain the operation in detail including the preferred technique in your case
  • Follow Pre & post operative instructions
  • Avoid strenuous activity and Lifting heavy weights before & for a few months after surgery.

FOLLOWING SURGERY VERY SOON U WILL BE BACK TO doing the things you enjoy most.