HYDERABAD: A hernia occurs when the contents of abdomen bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue known as omentum, are covered by a thin membrane ( Sac ) that lines the inside of the abdomen. Most of the Hernias occur in the lower abdomen in and around the genitalia.
Is Hernia harmful?
Hernias in the early stage are harmless, but they have a risk of getting irreducible and their blood supply may cut off resulting in tissue death. If the hernia sac contents have their blood supply cut off at the inner opening in the abdominal wall, it becomes an emergency and is it is a life-threatening condition.
What are different types? Inguinal hernia: Occurs more frequently in men (up to 25 times more common in men than in women). About 75 per cent fall in this category and are further divided into two types:
Indirect inguinal hernia: Occurs at any age.
Direct inguinal hernia: Occurs in the middle-aged and elderly because their abdominal walls weaken as they age.
Femoral hernia: These are rare but are common in women; they have more risk of becoming irreducible and strangulated.
Umbilical hernia is often noted at birth as a protrusion at the naval. This is a birth defect, usually closes by the age two years, when the opening is small but larger defects need to be operated as early as the baby is fit for undergoing operation. This condition is also seen in obese and elderly people and middle-aged women who have had children owing to which they repeated undergo stretching of abdominal wall during pregnancy.
Incisional hernia occurs mainly in lower abdomen owing to a weak scar in about 2 – 10% of all abdominal surgeries. Even after repair, incisional hernias have a high rate of failure (20 – 45%). With the advent of Mesh Repairs, both open and laparoscopic procedures are working.
Epigastric hernia: In this type of hernia a bulge, which is usually composed of fatty tissue and rarely intestine, is present above the navel in the midline of the abdomen. These hernias are often painless and cannot be pushed back into the abdomen when first noticed and require operation when they become painful.
Increased risk of getting hernia?
What are the signs and symptoms of hernia?
In hernia swelling or bulge may become painful: a dragging type of pain. This bulge increases on coughing or straining and reduces on lying down. Patient may have vomiting, constipation and abdominal distension if the hernia gets irreducible and leads to intestinal obstruction. If the treatment is delayed, you may get fever, sepsis and shock with hypotension as the intestines become dead and rupture within the sac.
How to confirm a Hernia?
Simple clinical examination is enough to confirm the diagnosis of hernia, but early hernias may require an Ultrasound examination, more so in obese people. In incisional hernia CT scan may be required in some patients to confirm the contents of hernial sac and to know the size of defect and if any adhesions have occured.
Is surgery?
Surgical repair of hernia depends on whether the hernia is reducible or irreducible. Hernias with large openings have a very low risk of complications and does not require surgery. All irreducible hernias need emergency treatment because of the risk of strangulation. An attempt to push back the hernia with medicine for pain and muscle relaxation has to be made with elevation of foot end of bed. If this attempt fails, emergency surgery is needed.
How is Hernia repaired?
There are several procedures to repair different types of hernias. In a standard repair, under anesthesia, an incision is made over the area of the hernia and all the normal tissues from the margins of the hole or weakness are separated layer by layer. The hole is then closed by stitches to approximate the nearby healthy and tough tissue. When a repair is done by stitches alone, the edges of the defect are pulled together which leads to tension in the area and results in pain.
In order to provide a tension free repair and avoid the stress on the adjacent tissue caused by pulling the tissue around the hole, a synthetic Mesh is placed on the defect and stitched over the defect.
What about Laparoscopy?
With the advent of keyhole surgery hernias can now be safely repaired with less scarring and blood loss. The added benefit of early return to work and reduced hospital stay apart from the absence of pain and reduced recurrences have led to more number of Laparoscopic TEP repairs of hernia. This procedure needs expertise and is safer in the hands of experienced surgeons. Bilateral hernias can be better tackled by laparoscopy with three small cuts. Incisional hernias less than 10 cm diameter can also be better repaired laparoscopically.
Any tips to prevent Hernia?