What do you know about Hernia ?

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Inguinal Hernia

Inguinal hernias occur when part of the membrane lining the abdominal cavity (omentum) or intestine protrudes through a weak spot in the abdomen — often along the inguinal canal, which carries the spermatic cord in men.

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Symptoms

Many patients with inguinal hernia presents with Complaints of a painless bulge or pain in the groin without bulge.

This Burning or pinching sensation in the groin which may radiate scrotum, labia or vagina, down the leg or around the back

They may have worsening pain with prolong sitting prolong standing bending coughing, straining or towards the end of the day.

Lying flat almost always results in improvement of symptoms.

Complications

Pressure on surrounding tissue – inguinal hernias does not go away it self and it enlarge over the time if they are not surgically repaired. This may even extend to scrotum causing pain.

Incarcerated hernia- loop of intestine trapped in the defect of the abdominal wall and it can lead to intestinal obstruction.

Strangulation – incarcerated hernia will cut off blood supply to intestinal loop. This is life threatening and patient should undergo immediate surgery.

Diagnosis – diagnosis of hernia is based on physical exam. Ultrasound study will be helpful.

Treatment

Conventional Open hernia repair with Mesh

The surgeon makes an incision in your groin and pushes the protruding omentum or intestine back into your abdomen. The surgeon then sews together the weakened or torn muscle. The weak area often is reinforced and supported with a synthetic mesh.

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Laparoscopic Hernia Repair

In this minimally invasive procedure, the surgeon operates through several small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through another incision to repair the hernia using synthetic mesh.

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This has growing popularity because of the shorter recovery time and less post -operative pain, lower complications and lower recurrence rate as compared to the open repair.

How you should take care of yourself after surgery?

You want to prevent infection, enhance healing, and avoid brisk coughing and weight gain.

  • Showering: Depending upon the type of repair you had and the type of dressing applied by the surgeon, you may be able to shower in a day or two.
  • Walking: Do it. It increases circulation, which speeds healing, but doesn’t strain the abdomen.
  • Eating: A diet high in fiber, fresh fruits and vegetables, along with drinking lots of fluids, will help avoid constipation (which can be caused by pain medication and inactivity) and the strain that goes with it. Surgeon might prescribe you stool softener or laxative
  • Lifting: Avoid it for at least the first few days. Then lift only very light objects that are easy to manage. As you slowly begin to lift more, use your knees and your back, not your abdominal muscles.
  • Working: Some people return to work within a week. It will depend on the type of surgery you had and the type of work you do. After Laparoscopic repair you can return to work early.
  • Sports: You will not be able to play sports or engage in strenuous exercise for a few weeks. It will depend largely on the type of surgery you had – and the type of activity. Make sure to ask your doctor about resuming exercise routines or playing sports.
  • Sex: Ask your doctor when it’s appropriate for you to resume sexual activity. Your physical comfort will provide a good guide.

 

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Umbilical Hernia

An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well.

Symptoms

Umbilical hernias that appear during adulthood may cause abdominal discomfort. These patients usually presents with bulge near the naval.

Complications

Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to umbilical pain and tissue damage. If the trapped portion of intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdominal cavity, causing a life-threatening situation.

Adults with umbilical hernia are somewhat more likely to experience incarceration or obstruction of the intestines. Emergency surgery is typically required to treat these complications.

Diagnosis

Diagnosis of hernia is based on physical exam

In adults underline causes, anything that increase intraabdominal pressure needs to be consider before definitive treatment. Constipation, Difficulty in urination and chronic cough can be potential causative agents.

Treatment

Laparoscopic inguinal Hernia repair.

In this minimally invasive procedure, the surgeon operates through three small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through another incision to repair the hernia using synthetic mesh which is anchored to inner surface of the abdomen using Tacker which is a surgical fastening device that dispenses tacks into tissues.

By

Dr. Nishan Gunarathna
MBBS(Colombo, Sri Lanka)

image credits: http://www.algarlife.com

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