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

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?

There has been an intense debate, which is in the loop for years and has been raging back and forth regarding the deficiencies of a vegetarian diet versus the perils of a non-vegetarian one. This heated debate is both accurate as well as unfounded. Probably, that s the entire reason it is still a debate. In fact, if you look into the diet of both groups, you will be able to identify the fact that, there is a space for healthy living in both.

Vegetarian Diet

In a vegetarian diet, the food intake of a person is confined to a large variety of foods derived from plants along with milk and dairy. And, any form of meat and products derived from animals are completely avoided.

Pros

Vegetarians have been noted to consume lesser amount of proteins, but they do not suffer from problems related to a high protein diet, such as osteoporosis (characterized by brittle and weak bones) and kidney failure.
The diet includes high level of antioxidants such as vitamin E & C as well as carotene, which is available in vegetables and fruits.
Additionally, they consume less amount of saturated fats.
Cons

Deficiency of vitamin B12 is common amongst vegetarians, as it is mainly available in meat, eggs and fish. Deficiency of vitamin B12 can yield rare symptoms such as increased fatigue, shortness of breath and a temporary loss of body balance.
Lack of protein, as stated above, along with iron and zinc deficiency is also common. 
Symptoms of protein deficiency can be troublesome and include signs like

Sluggish metabolism
Loss of body muscles (as the body tries to derive the regular protein intake from your muscles, thus making them weak),
Trouble gaining or losing weight
Persistent fatigue
Longer healing time in case of wounds and injuries
Pain in joints
Drastic changes in blood sugar level that might result in diabetes
A weak immune system makes you vulnerable to all kinds of diseases.
Non-vegetarian Diet

A non-vegetarian diet includes all forms of plant foods as well as foods and by-products that are derived from animals, such as poultry, fish, meat, etc.

Pros 

Vitamin B12 is present in adequate level since they are derived from sources such as meat, eggs and fish. Adequate intake of proteins is never an issue for  non-vegetarians
Cons

Meat products are loaded with saturated fats, which increase the risk of heart diseases. Studies have shown that people consuming non-vegetarian diets:
Have shorter lifespan and are more vulnerable to chronic diseases.
Tend to develop diabetes, heart diseases and hypertension.
Usually non vegetarians eat less amount of vegetables and fruits than what is recommended.  
If you wish to discuss about any specific problem, you can consult a Dietitian/Nutritionist.

Vegetarian vs Non Vegetarian Diet - Which is Better?

When an organ residing in a cavity such as the abdomen tries to push through the muscular layer it resides, it is called as hernia.

Though said to be genetic, hernias can be caused by things such as improper heavy lifting, incorrect posture, or chronic constipation and as a result of surgical complication or injury. Factors like obesity, pregnancy, smoking, chronic lung disease aggravate the severity of the hernia. It is believed that about 27% of all males and 3% of females can have a hernia during their lifetime.

Types of hernias:
Inguinal hernia - The groin is the most common area, where the abdomen pushes through a weak spot in the lower abdominal wall, causing a protrusion into the inguinal canal. More common in men than women.

Hiatal hernia - The abdomen has the diaphragm separating it from the thoracic cavity in the upper border. When it pushes through the diaphragm, a hernia is caused and there is almost always associated food reflux in these cases. Though the most common cause is associated old age, due to muscle weakness, there also are cases of congenital hiatal hernias.
Umbilical hernia - The abdomen finds a weak layer along its length and protrudes through the skin on the stomach. Most commonly seen in babies around the bellybutton, it gradually corrects itself on its own. Quiet rare in adults, seen during pregnancy and in chronic obese people.
Incisional - These are post-surgical, and happen when the organ protrudes through the weakened wall due to surgery. The abdomen is again the most common area and the hernia can happen either onto the external surface or internally, when they are called ventral hernias.
These are the most frequent types, though hernia affects other organs like the spine, brain, appendix, etc.

Treatment - This includes a combination of constant monitoring followed by a decision to do surgical treatment. Hiatal hernias and umbilical hernias can be monitored for a while before deciding on surgery. Inguinal hernias may require surgery earlier in the stage. Post-surgery, a mesh is placed to hold back the tissue in its corrected place. The umbilical hernia in children could be self-limiting. If it does not get auto-corrected in the first year of life, that also would qualify for a surgical treatment.

Dependent on each patient, hernias need to be managed under medical supervision.

Hernia - What Should You Know?

Anti-reflux surgery (Fundoplication) is a procedure for treating gastroesophageal reflux disease (GERD) incorporated in hiatus hernia operation. GERD occurs when stomach contents reflux and enter the lower end of the esophagus (LES) due to a relaxed or weakened sphincter or a hiatus hernia. GERD is very much treatable and can cause serious complications if left untreated. 

GERD symptoms
The main symptom of GERD is heartburn or indigestion, along with other symptoms, such as 

Acidic sour taste in the mouth
Burning pain in the throat
Difficulty in eating
Bloating and belching
Stomach pains
Regurgitating food
Nausea
Vomiting blood
Dark tarry stools
Laparoscopic Anti-Reflux Surgery
Laparoscopic surgery reinforces the lower oesophageal sphincter s ability to prevent gastroesophageal reflux from occurring. The surgery involves wrapping the top part of the stomach around the lower end of the esophagus and suturing it in place. Since the esophagus passes through the hiatus, suturing is done to narrow the hiatus as it helps in the prevention and treatment of concurrent hiatal hernia.

Laparoscopic Surgery Procedure
A laparoscope, a long, narrow telescope with a light source and a video camera at the end, is inserted through a tiny incision into the abdomen. Images from the camera are projected onto a large high definition monitor for the surgeon to view enlarged images as it helps the surgeon perform surgery with precision.

The patient is placed under general anesthesia
The surgeon makes a small incision in the upper abdomen and inserts the laparoscope into the abdomen.
The surgeon introduces carbon dioxide into the abdominal cavity near the belly button to expand the viewing area of the abdomen giving the surgeon a clear view and room to work.
Additional small incisions are made for a variety of surgical instruments to be used during the procedure.
After the identification of critical structure, the hole in the diaphragm, through which the esophagus passes, is then tightened with sutures.
The surgeon wraps the upper part of the stomach around the lower esophagus guided by the images on the laparoscope, then creates a valve which is precisely sutured in its place.
The laparoscope and other instruments are removed and the gas is released.
The tiny incisions are closed and covered with waterproof dressings to avoid any kind of infections.
The patient is usually discharged within 1-2 days of the surgery.
Post-surgery, hospitalization is required just for one day - no bed rest is required after that. The patient can quickly return to all normal activities and immediate relief from symptoms also happen. 

Laparoscopic Surgery - How It Can Help With Anti-Reflux and Hernia?

Umbilical Hernia is a common condition in infants in which the intestine protrudes or pokes out through the abdominal muscles in the navel area, where generally the Umbilical cord is located. Umbilical Hernia is generally harmless if not sore and is evident when the bellybutton protrudes. During childhood, Umbilical Hernia closes on its own, but sometimes when it does not, it might require a surgical correction during adulthood. This condition is commonly seen in premature babies and can be diagnosed through physical examination alone.

Symptoms

Umbilical Hernia causes swelling or bulging near the navel and is generally visible under normal circumstances. However, in some cases, the protrusion occurs only when the baby strains, coughs or cries. Though this condition is painless, it can cause discomfort during adulthood. To avoid complications, it is advisable to seek professional help even if the condition initially seems harmless. There might be symptoms of pain, swelling, discoloration, and tenderness in the navel, accompanied by vomiting sometimes.

Causes

When the fetus is still unborn and in womb, the umbilical cord passes abdominal muscles of the baby through a small opening, which generally closes post birth. But in case muscles fail to completely join the midline of abdominal wall, this condition appears post birth, and sometimes later in life.

During adulthood, when there is too much pressure on the abdomen, it leads to this condition. This pressure might build up due to a number of causes like multiple pregnancies, obesity, previous abdominal surgery, ascites (fluid in the abdominal cavity), and long-term dialysis for kidney function.

Complications

Complications might be caused when the protruding part of the intestine gets incarcerated or trapped and fails to push itself back into the abdominal cavity, reducing the blood supply. This leads to tissue damage and umbilical pain. If the blood supply totally fails, tissue death leads to gangrene, causing infection, and posing a life-threatening situation. In such cases, surgery might have to be performed in an emergency.

Treatment

Most of the times, abdominal tissue pushes itself back but sometimes, it has to be done by an experienced medical professional. When this cannot happen, surgery has to be performed to correct the situation. The surgery can be open or laparoscopic.

A small incision is made at the base of the bellybutton during surgery, which is a small and quick procedure. The hernia is corrected and sutures close the incision. For adults, sometimes mesh is used for strengthening the abdomen during open surgery.

Take Away

Umbilical Hernia is a condition in which the intestine or abdominal tissue protrudes through the abdominal muscles in the navel area, where generally the Umbilical cord is located. It is a harmless condition but sometimes painful. Generally, it corrects itself but when it fails to do so, corrective surgery is required which can be open or laparoscopic.

 Umbilical Hernia - How To Manage It?

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