Hernia Management I Kilpauk, Chennai, Tamil Nadu

When tissue protrudes through a defect in the encapsulating walls, a hernia occurs. Hernia repair surgeries are a general option for such deformity. But even before undertaking a surgical repair, a manual reduction of the hernia usually pushes it back into its compartment. This mitigates any associated symptoms and helps avoid adverse outcomes of strangulation and any event of elective surgical repair.

The irreducible hernia is also known as incarcerated hernia. This cannot be returned back to its original chamber. The skin overlay may appear normal, the contents are not tense and bowel sounds can be heard. Abdominal contents or the bowel omentum make up the incarcerated hernia.

Blood supply to the herniated tissue is compromised in a strangulated hernia and hence a medical emergency. The herniated bowel contents pass through an opening the subsequently reduces venous return. This leads to an edematous tissue, compromised circulation and arrest of arterial supply. Strangulated hernias can prove fatal if left untreated. When blood supply stops, it results in a dead intestine and bowel that releases toxins into the blood stream causing septicemia which can even lead to death. Small hernias tend to be strangulated rather than large ones.

When the contents of the abdominal cavity protrude through the inguinal canal, it is called an inguinal hernia. Pain and discomfort is present when coughing, exercising or during bowel movements. Usually improved when lying down, it tends to worsen through the day. When bearing down, the bulge seems to become larger. An inguinal hernia occurs on the right side rather than the left. 75% of all abdominal wall hernias account for inguinal hernias. Repair of the inguinal hernia is one of the most popular surgeries performed around the world.

Femoral hernias are fairly uncommon. Also known as a femorocele, women are more likely to suffer from a femoral hernia than men. Estimates reveal that 1 in 20 groin hernias are femoral. The rest of them are inguinal hernias. A painful bulge forms in the inner (upper) part of the thigh or groin. Due to over-strain, a portion of the intra-abdominal tissue pushes its way through a weak spot in the muscles. When these tissues push its way through the wall of the femoral canal, it is called as a femoral hernia. The femoral canal consists of small veins, nerves and the femoral artery and is located just below the inguinal ligament. Again, most femoral hernias do not reveal any symptoms but if it obstructs, can cause severe problems and is deemed as a medical emergency due to strangulation.

About 10 to 12% of abdominal wall hernias are umbilical hernias. Their development is associated with increase in intra-abdominal pressure and weakness of the fascia at the umbilicus level. These hernias have a narrow neck, which is a disposition for high risk incarceration and strangulation. The small bowel, omentum and colon make up the contents of the hernial sac.

When hernias occur in the midline of the abdomen, they are known as midline hernias. They are only second to the most frequent groin hernias. Midline hernias occur just adjacent to the umbilicus and are considered very complex. They are small and a direct result of poor healing of an incisional hernia from a prior surgery. When a wound in the abdominal wall does not heal, the underlying intestine protrudes through the defect resulting in a hernia. The defect can be large and require careful evaluation. In such cases the muscles are deficient and expert surgical intervention and reconstruction may be required.

Hernia recurs in about 10% of the patients who have undergone a primary inguinal herniorraphy. A second repair of such a hernia can be daunting. It requires the expertise and precision of an experienced surgeon. It is a delicate surgery because the tissues have already weakened and the anatomy is obscured and distorted. A definite repair approach for a recurrent hernia is the laparoscopic approach due to the high rate of failures with the open anterior approach. Laparoscopic repair of the recurrent hernia is proven to be one of the safest alternative procedures with minimal complications.

Hernias can be internal or external and abdominal or thoracic. Where both these hernias are spontaneous in occurrence due to congenital defects, incisional hernias are very common and often occur after surgery. They can range from small to large defects. Loss of domain is a condition where the hernial defect is so large that the contents become irreducible due to a chronically injured abdominal wall. Incisional hernias are a result of technical and biological factors when the fascia does not heal after the surgery. Due to the mechanical failure the myofascial defect is concealed by the healing skin and gets enlarged. The bundles of collagen along the abdominal wall are oriented transversely suggesting that a transverse suture line provides mechanical stability. Fibers are encircled rather than split. Higher incidences of an incisional hernia formation are observed in upper midline hernias and perioperative shocks.

When a prolapse of a section of the stomach occurs into the diaphragmatic esophageal hiatus, it is called as a hiatal hernia. Incidentally discovered, most hiatal hernias are asymptomatic. It is rare that a hiatal hernia presents itself an acute life-threatening complication.

Inguinal hernias are congenitally present in children. Operative treatment is mandatory for all paediatric inguinal hernias to prevent complications of incarceration and strangulation. Inguinal hernia occurs as a result of failure of luminal obliteration of the processus vaginalis. At this time the abdominal contents herniated into a ready-made sac. The common type of hydrocele is the communicating hydrocele where abdominal cavity fluid freely enters into the scrotal sac with patency of the proximal processus vaginalis.

This page will deal with both stoma hernias and stomal or parastomal hernias. Both are considerably different.

Also known as hiatal hernia, a hiatus hernia occurs due to the prolapse of the stomach through the esophageal hiatus. The esophagus connecting the mouth and the stomach passes through a gap in the diaphragm, called hiatus. The weakened area of the hiatus causes clamping of the entry of the stomach. Due to this, acidic juices are pushed up into the esophagus causing reflux (gerd). A painful and burning sensation along with chest pain extending below the shoulder blades is experienced by the patient. A hiatal hernia is normally discovered when a patient is being evaluated for gerd.

A surgical intervention is by far the best method to treat a hernia. It provides long lasting relief and mobility to the patient. Hernia repair is a very common surgery with routine procedures.

Hernia is due to a natural weakness in the abdominal wall or excessive strenuous activity such as lifting heavy weights or obesity, difficulty in bowel movements and strain during urination. The patient experiences pain while lifting objects and there is an evident protrusion noticed in the groin area. Nausea and constipation are accompanying symptoms of a hernia. All ages, men, and women are prone to a hernia. Most of the hernias are inguinal or in the groin area. Others are femoral or below the groin, umbilical or through the navel and incisional hernia occurring at the site of a previous surgery.

The single incision laparoscopic surgery is known by several names and acronyms. They are: spl – single port laparoscopy spa – single port access spices – single port incisionless conventional equipment utilizing surgery saes – single access endoscopic surgery less – laparo-endoscopic single site surgery notus – natural orifice transumbilical surgery opus – one port umbilical surgery

Robotic surgery uses the help of a robotic arm with tiny tools attached to its end. Massive technological developments have enabled systems to aid in surgical procedures. Any persistent limitations of minimally invasive laparoscopic surgeries are overcome with robotically-assisted surgery. The instruments are controlled either with a computer or a remote telemanipulator. Normal movements pertaining to the surgery are carried out with the robotic arm and the guidance of the manipulator. Some ancestors of the latest robotic da Vinci surgical system are The Puma 560, The Probot, The Robodoc, Aesop, and Zeus. The da Vinci surgical system is the most advanced robotic technology, facilitating complex surgeries using a minimally invasive approach for gynaecological surgeries, cardiac valve repairs and even more.