Laparoscopy surgery is a very vital component of the hernia repair. Studies have shown that many patients have a better outcome when they opt for laparoscopic surgery. Candidates eligible for this mode of surgery include those with bilateral inguinal hernias, ventral hernias, and recurrent hernia. People associated with athletics and other outdoor sports prefer to go for a laparoscopic hernia surgery as it ensures a speedy recovery and minimal tissue invasion (due to small incisions).

Laparoscopic hernia repair- inguinal
A laparoscopic surgery requires an incision of 1-2 cm at the belly (at the lower end). Two small punctures are done near the umbilicus. The punctures are done to make room for the cameras so that the surgeon is able to view the abdomen clearly. The smaller incisions allows the operating instrument to enter into the stomach.

The Procedure:
A balloon is placed in between the abdomen and the overlying muscle so that the peritoneum can be separated. When space is successfully made, the camera comes into the action to view the condition of a hernia. A hernia is pulled from its hole into the abdomen. Once the hole is detected, the defect of a hernia is fixed.

Laparoscopic hernia repair- incisional/ventral: Laparoscopic hernia repair is suitable for all types of a hernia such as an umbilical hernia, ventral hernia, recurrent umbilical hernia, epigastric hernia etc. Just like an inguinal hernia, A camera is placed into the abdomen through the muscles. Two small incisions are made for the operating instruments to get through. This is followed by the cutting of the tissue that is placed between a hernia and the intestine. The hole thus gets exposed. Through one of the laparoscopic ports, the hernia mesh gets rolled and is placed into the abdomen. A hernia is then pulled up and the mesh gets secured with 4 sutures. A special device is used to fix the healthy muscle.

Tension free repair: Tension free  repair is often used to symbolize hernia surgery. A hernia is often triggered by the weakened muscles. Few surgeons endeavors to sew the muscle around the area of a hernia. Since the muscles surrounding the hernia are weak in the first place, they pull apart causing a recurrence of a hernia. To avoid this, most surgeons use a mesh to strengthen the cells around the hernia region. This procedure ensures that the muscles aren t sewn but the mesh placed over the hole can prevent the muscle to push through the walls of the abdomen.

The use of mesh: There are some reservations about using the mesh in a hernia surgery. However, this is the safest and most appropriate way to perform a hernia laparoscopic surgery. The use of a mesh also negates the risk of open incisions and recurrence of a hernia.

Types of Hernia - How Laproscopy Can Help Manage?

Hernia refers to the condition when an organ or fatty tissue inside the body begins to protrude from its location. Hernias are mostly detected in the groin, belly, or the stomach region. They occur because of muscle weakness in the said region where it is detected but they can be treated with surgery. In most cases, a surgery is prescribed and laparoscopic hernia repair is a very popular surgical procedure that has proven to be successful in most of the cases. This is why a growing number of patients decide to go for it.

Laparoscopic hernia repair: procedure: In this surgical procedure, a laparoscope (an instrument with a high-resolution camera and high-intensity light) is passed inside the abdomen through small incisions that varies between 0.5 and 1.5 inches in length. When the laparoscope moves inside the abdomen, it sheds light on the hernia and sends the images to the monitor connected to it. The surgeon views the hernia on the monitor and then the abdominal cavity is made to swell with carbon dioxide so that the surgeon can find enough space to operate the hernia. Once this is done, the surgeons operate the hernia with tiny surgical instruments. Once the hernia is removed, space or the hole is covered with a mesh from inside the abdomen.

Advantages of laparoscopic hernia repair: The laparoscopic procedure is popular because it is comfortable for the patient in many ways. They have to endure lesser post-operative pain as compared to open surgery, which means the recovery is quicker. They require lesser drugs for healing and the patient can get back to work in fewer days. It is an advanced form of surgery and thus, gives better results.

Disadvantages of laparoscopic hernia repair: While the non-invasive laparoscopic surgery has several advantages, it also comes with some drawbacks. It is lengthier in comparison to open surgery and also costs more. It cannot be performed by all the surgeons and only those who are skilled in this type of surgery can do justice to the different cases of a hernia. 

Recovery after laparoscopic hernia repair: The patient takes one to two weeks after the surgery to return to light activity and daily routine. Nevertheless, heavy exercise and strenuous activity should be avoided until four weeks after the surgery. The full recovery time differs from patient to patient depending on their age, gender, and health condition but one month is the average time for full recovery.

555 Manish Technique for inguinal hernia repair:

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.

555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

Laparoscopic Hernia Repair - What Should You Know

What do we mean by a hiatal hernia?

The hiatus is an opening in the diaphragm (the muscular wall) which separates the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening.

What does statistical data say about a hiatal hernia?

Statistically, approximately 60% of individuals who are above age 50 or older have a hiatal hernia.

In which age group is hiatal hernia very common?

The incidence of hiatal hernias increases with age. It is commonly seen in the older age people specifically in people who are above 50. 

What are the causes of hiatal hernia?

The most common risk factors are as follows: 

Obesity Congenital deformities, such as scoliosis
Certain types of surgery
Major trauma
Conditions which causes an increase in abdominal pressure within the abdomen, such as heavy lifting, or bending over, frequent or violent coughing, violent sneezing, violent vomiting, and straining during bowel movements
What are the types of a hiatal hernia?

There are four types of a hiatal hernia and they are as follows:

Sliding hiatal hernia: This is the most common variant of a hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. It is usually asymptomatic.
Fixed hiatal hernia: It is also known as a paraesophageal hernia. In a fixed hernia, part of the stomach pushes through diaphragm and stays there.
Type III hiatal hernia: In this type, as a hernia goes on increasing, the phrenoesophageal ligament stretches and displaces the gastroesophageal junction above the diaphragm
Type IV hiatal hernia: Type IV hiatal hernia includes a large defect in the phrenoesophageal ligament causing other organs, such as colon, spleen, pancreas and small intestine to enter the hernia sac.
What are the sign and symptoms of hiatal hernia?

Common symptoms include:

Heartburn
Chest pain or epigastric pain, coughing
Difficulty in swallowing
Belching, eructation, and hiccups
How to diagnose the condition?

To diagnose this condition following tests or procedures are included:

X-ray of the chest and abdomen Barium follow-through examination of gastrointestinal tract (GI) to visualize GI tract.
Upper endoscopy for examining the esophagus and stomach from inside Esophageal manometry for measuring the rhythmic muscular contractions of esophagus while swallowing, and also, measuring the force exerted by the muscles of esophagus.
What is the treatment available for it?

It includes medications and surgery which are as follows:

Antacids to neutralize stomach acid and to reduce acid production
Medications that heal the esophagus 
Surgery of opening of diaphragm to make it smaller and for reconstruction of an esophageal sphincter

Hiatal Hernia - How Is it Diagnosed?

An inguinal hernia refers to the condition when tissues, such as those which are a part of your intestines, find a weak spot in your abdominal muscles and protrudes outwards. This may often result in a painful bulge, especially at times when you bend over, lift heavy objects or cough.

Usually, if the hernia is small, your doctor might just ask you to wait and leave it untouched. In children, manual pressure may also be applied to reduce bulging. Enlarged or very painful hernias, however, require surgery for the prevention of complications and for relieving discomfort.

Generally, there are two types of hernia repair surgeries which are as follows:

1. Open hernia repair surgery: This type of surgery is carried under sedation by local anaesthesia, and ensures an incision being made in the groin to push back the protruding tissues into the abdomen. The weakened area is then sewn back, and reinforced with the help of a synthetic mesh, a procedure called hernioplasty. The opening is then closed down using staples, surgical glue or stitches. Though movement as soon as possible is recommended, exertion must be avoided.

2. Laparoscopy: This is a kind of minimally invasive surgery, done with the aid of local anaesthesia. In this procedure, multiple small incisions are made in the abdominal region and then gas is used in order to inflate it, to make visibility easier.

A tiny camera is attached at the end of a small tube (a laparoscope) and then inserted into the cavity created by the incision. With the aid of the increased visibility facilitated by the camera, the surgeon then inserts other tiny instruments through the remaining incisions for repairing the hernia, with the help of a small synthetic mesh.

This kind of surgery allows your surgeon to avoid the scar tissue which might be present from a hernia and which might have been repaired earlier. Laparoscopy is thus also recommended for those with bilateral hernias (on both the sides).

However, research has shown that this kind of repairing may also increase the likelihood of recurrence or some other complications or risks.
Risks are usually reduced when the surgery is performed by a surgeon who has a lot of prior experience in the same.

Inguinal Hernia Treatment

Recovery from a hernia after the surgery will need a time of approximately 2-3 weeks. The time for recovery also depends upon the surgery performed. An open surgery performed through a large incision across the region of a hernia will require a longer hospital stay and a longer time for recovery, whereas, in contrast, a laparoscopic surgery performed with 2-3 small incisions will heal faster and will need a shorter hospitalization.

The recovery process can be speeded up by taking appropriate care, and recovery tips for it are as follows:

Medication should regularly be taken as recommended by the doctor to lessen the symptoms of the surgery. 
Wound care should be taken properly. 
Dressings should be kept clean and dry, and they need to be changed very frequently in order to avoid the infection.
A persistent cough and sneezing need to be treated with the proper medication. 
Keep a pillow nearby. 
Every time while coughing and sneezing hold the pillow over the suture in order to prevent pressure on the sutures. 
Use an abdominal binder of a proper size. It supports the abdominal muscle and maintains abdominal pressure.
Use clothing which is expandable and has elastic waistbands whenever there is swelling. 
Swelling over the incision is a common complication after the surgery. Thus, the incision area should not be closed tightly by wearing tight clothing. 
Wearing expandable cloths will give more comfort and will not cause pain due to pressure. Take a stool softener before and after surgery. 
Constipation should be treated before the surgery and should be avoided after the surgery by using stool softeners. 
Straining for the stools will create pressure over the incision and hernia repair site and will delay the recovery. 
Eat healthy food. The food should be fiber-rich as it will help to improve the bowel movements, and it will avoid the risk of constipation.
Drink plenty of water to avoid constipation and improve the bowel movement.
Do not bend to pick up the things or maintain personal hygiene, i.e., cutting toenails as it will create pressure on the sutures and it may break open.
Avoid lifting of any objects as it will create pressure on sutures and will increase the risk of rupture. After a certain period of time, lift only light items (less than 20 pounds), and always use back muscles and knees. 
Do moderate exercises, such as walking, as it will speed up the recovery. Do not start with heavy exercises. 
Smoking should be avoided after the surgery as it will improve breathing and blood circulation, which will help in the healing process.

Hernia Surgery: Quick Recovery Tips!

A Hernia may be defined as the protrusion of an organ into an adjacent connective tissue or muscle. The protrusion usually occurs through a tear or a weakened area in the muscle (Fascia). Hernia can be an Inguinal Hernia, Umbilical Hernia, Hiatal Hernia or Femoral Hernia. It can also originate from an incision (Incisional Hernia).

The Inguinal Hernia is commonly observed in males. Here, the intestine squeezes through a tear in the abdominal wall into the groin (Inguinal canal). At times, the small intestine bulges through the abdominal wall (weak spot) near the belly button, which results in Umbilical Hernia. In Hiatal Hernia, the upper part of the stomach passes into the chest through the diaphragm, and of all the hernia types, the Inguinal Hernia is the most common.

Severe strain and muscle tear or weakness can result in Hernia. Obesity, chronic constipation, chronic coughing and sneezing, ageing, damage caused by injury, medical conditions like Cystic Fibrosis, contribute to increased incidences of Hernia. In case of Hernia, the affected area tends to protrude or bulge out. If left untreated; Hernia can prove to be detrimental. One needs to consult a physician for proper diagnosis and treatment. Physical examination can help in the diagnosis of Inguinal Hernia. An ultrasound is needed to diagnose Umbilical Hernia. A Barium X -ray or endoscopy can be of great help in the diagnosis of Hiatal Hernia.

The severity of the Hernia depends upon its size. In case the Hernia is rapidly increasing in size, a surgery is needed for the repair. The surgery performed can be open or laparoscopic. In open surgery, Hernia is identified through an incision. Once located, the Hernia is removed from the adjacent tissues. In laparoscopic repair, small incisions are made in the affected region. Through these incisions, specialized instruments are inserted. It is through these instruments that the surgeon visualizes and performs the surgery.

In such repairs, a mesh, held in place by sutures is used as a scaffold. This facilitates the growth of new tissues in the affected person. This technique significantly lowers the chance of a recurrence. Certain factors must be well addressed, before performing a Hernia operation:

* Hernia operations, laparoscopic in particular, should be performed by experienced surgeons. Inexperienced surgeons will do you more harm than good.
* Laparoscopic Hernia operation should be avoided in case a patient has adhesions from previous surgery.
* Extreme care should be taken while performing a Hernia operation in infants and children.
* In some cases, Hernia surgery might affect or injure the vas deferens in men. This in turn can affect fertility in men.

What To Know About Hernia Operation

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