Hiatal hernia takes place when the upper portion of the stomach pushes itself through an opening in the diaphragm, into the chest cavity. The diaphragm is a wall of thin muscles, which separates the chest cavity and the abdomen. In most cases, a small hiatal hernia doesn't cause problems and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition.

But a large hiatal hernia can allow food and acid to back up into your oesophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

Causes

Hiatal hernia is primarily or most commonly caused due to the increase in pressure in the abdominal cavity. Sometimes, a lot of pressure may be felt around the stomach accompanied by coughing, vomiting, strain during bowel movements. For people born with an abnormal hiatus, the chance of getting hiatal hernia is more.

The two common types of hiatal hernia are:

 Sliding hiatal hernia, which occurs during the sliding out of the stomach and oesophagus into and out of the chest through the hiatus. This type of hiatal hernia is less intense and has no symptoms.
 Fixed hiatal hernia or paraoesophageal hernia is an uncommon type of hernia where a part of the stomach pushes through the diaphragm and stays there.

Symptoms

Usually, no symptoms are experienced during hiatal hernia. Some symptoms are experienced that happen due to stomach acids, bile or air, which enters the oesophagus. Some common symptoms include:

 Heartburns which become worse when a person lies down
 Chest pain, better called epigastric pain
 Problem in swallowing food
 Belching

Tests for diagnosis

Several tests can be carried out for the diagnosis of hiatal hernia. They include:

 Barium x-ray, where a person is made to drink a liquid filled with barium before the x-ray. The x-ray provides a clear image of the upper digestive tract region and the location of the stomach can be seen. If it is protruded out, hiatal hernia is signified.
 Endoscopy is another test for detection of hiatal hernia. A thin tube slides down the throat, which reaches up to the oesophagus and stomach. This will determine whether the stomach is pushing through the diaphragm or not.

Treatment

Medicines, which are used to cure a hiatal hernia may include antacids for neutralizing stomach acid, h2 receptor blockers to lower acid production and proton pump inhibitors. Sometimes fundoplication surgery is required for the treatment of hiatal hernia, although it is rare. Some common surgical techniques are rebuilding of oesophageal muscles or a surgery to put the stomach back in its actual place. Laparoscopic surgery methods are used. Hiatal hernia may reoccur even after surgery; so general precautions should be taken. You should:

 Exercise regularly and maintain a healthy weight
 Avoid lifting heavy objects and ask for help
 Avoid any kind of strain on the abdominal muscles

Hiatal hernia is a disorder, which is more common among people over the age of fifty. Necessary precautions and treatment should be adopted in case of hiatal hernia.


All About Hiatal Hernia

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?

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

Umbilical hernia refers to a condition where your intestine protrudes through the opening of the belly button. This condition generally affects infants, but some people may suffer from it in adulthood as well. Umbilical hernias are common but do not cause any health issues in most cases. However, in some instances, the disorder leads to problematic symptoms.

Symptoms of umbilical hernia:

If you or your child suffers from the symptoms mentioned below, you should seek treatment.

  Pain
  Nausea/vomiting
  Discolouration and swelling at the region of the hernia

If one or more of these symptoms appear, seeking treatment at the earliest is necessary to avoid further complications.

Complications from umbilical hernia:

Even though complications from the disorder are rare in infants, they are not unheard of. The most common complication occurs when the portion of the intestine protruding from the belly button is trapped. In such a case, blood supply to this region is cut. This can lead to tissue death or gangrene. The infection slowly spreads to the rest of the digestive system, causing a life-threatening situation.

Adults who have umbilical hernia are more likely to suffer from complications of the condition.

Treatment for umbilical hernias:

Treatment differs based on the age of the patient. In most infants, the umbilical hernia does not produce any symptoms. In fact, such hernias typically disappear on their own after a year or two. A doctor may also be able to push the hernia in during a routine check-up. However, you should not try to do this yourself.

When is surgery needed for an umbilical hernia?

An infant requires surgery for the hernia if he/she experiences the following traits-

  Pain
  The hernia has a diameter larger than half an inch
  The hernia is large and does not decrease in size in the first two years of the child s life
  Does not disappear even when the child reaches the age of four
  The external portion of the intestine sticks out and gets trapped.

However, in the case of umbilical hernias affecting adults, a doctor will always recommend surgery to avoid possible complications arising from the disorder.

How is the surgery performed?
For both infants and adults with an umbilical hernia, the surgical procedure remains the same. The surgeon makes a small incision at the base of the belly button. The doctor uses this opening to return the external part of the intestine inside the abdominal cavity. Once this is complete, the doctor stitches the incision.

In adults, a supportive mesh is also used to ensure that the intestine does not protrude once more through the belly button.

Laparoscopic hernia repair is suitable for all types of a hernia such as an umbilical hernia. 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 healthy muscle.

Umbilical Hernia - Everything You Should Know About It!

With the growing market for organic products, there is a widespread confusion on which product to choose. The same dilemma holds good in selecting the type of bread. White bread or Brown Bread? People are not sure which one to eat to stay healthy. A few quick facts about the two types of bread and which one should be consumed to stay healthy, are given below

White Bread
White bread is made out of refined wheat flour that has nothing to offer for the body. During the process of making white bread, the bran and wheat germ is removed from the wheat flour and Potassium Bromate, Benzoyl Peroxide or Chlorine Dioxide gas are used for bleaching to generate the whiteness. Potassium Bromate is highly dangerous if consumed in large doses. Chlorine dioxide is also used as a pesticide and is considered hazardous to the environment. When a large amount of white bread is consumed, the refined carbohydrates generate high levels of insulin thus, resulting in higher chances of weight gain. In spite of being globally popular, white bread is highly unhealthy for your body. It is completely devoid of nutrients and it is as harmful as table sugar for the digestive system.

Brown Bread
The American Academy of Pediatrics has revealed that whole wheat brown bread is rich in nutrients compared to the white bread. One major factor contributing to the above-mentioned fact is the amount of fiber present in whole wheat brown bread. The increased fiber content slows down the digestion process and thereby, reduces the effect on blood sugar and production of insulin. Other nutrients that are present in brown bread include vitamin B6, E, Folic acid, Zing, Copper and Manganese. Brown bread has lesser amount of calcium as compared with brown bread. Many manufacturers claim that they produce brown bread with the same amount of calcium as in white bread. Whole wheat bread contains Phytonutrient also called as plant lignans that have been observed to protect against heart diseases and breast cancer.

Things to consider while buying Brown Bread
The declining demand for white bread has forced a lot of manufacturers to use caramel as a coloring agent to darken white to brown bread. So buyers need to carefully look for the ingredients mentioned in the packing to ensure that they are buying the right product. It is important to check the first ingredient to see whether it is whole wheat or whole meal flour. If the word "enriched" is used, it means that the same flour used for white bread is used. Look for the bread with the minimum ingredients to ensure that you get maximum nutrients and very little additives. Also, make sure the amount of the following ingredients are as given below; sodium should be lesser than 401mg, saturated fat should be 1gm and fiber needs to be 4gm per 2 slices of serving.

To conclude, when it comes to organic and fitness oriented scenarios, brown is always better than white.

White Vs Brown Bread - Which One Should You Eat ?

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

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