When an organ residing in a cavity such as the abdomen tries to push through the muscular layer it resides in, 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. This is 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. Hernias need to be managed under medical supervision.

Hernia - What You Should Know About It?

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!

A hernia occurs when a weakened area of muscle in the abdominal wall gives way and the internal organ/tissue bulges out through this weakened are or  defect'. This can happen in many different areas of the abdomen. A hernia that develops in the groin region is called "inguinal hernia". It may be very painful especially if a part of the intestine gets trapped in the bulge.

The only treatment option is surgical repair as the weakened area "defect" needs to be repaired and will likely need reinforcement by a prosthetic material called a "mesh". Doctors may resort to Open Surgery or Laparoscopic Inguinal Hernia Repair depending on his/her evaluation of the patient. 

Who is a candidate for Laparoscopic surgery?

Laparoscopic surgery is the preferred treatment option for most people with inguinal hernia. Special situations in which laparoscopic surgery is much superior to open are

  Failure of a previous open surgical repair. Laparoscopic surgery is performed from "behind" the hernia and abdominal wall in comparison to open surgery which is performed from "the front". So, in case of failure of the open surgery, laparoscopic surgery is done through a fresh, non-scarred area and is technically safer and easier than doing an open surgery once again.

  If there are hernias on both sides and both need to be repaired at the same time, laparoscopy has a great advantage as both the hernias can be tackled and repaired through the same three tiny cuts, and two separate large incisions need not be made. 

Who is Not a Candidate for Laparoscopic Surgery?

The person is not a candidate for Laparoscopic Surgery if he has:

  Some patients who have undergone previous Abdominal Surgery or prostate surgery may not be suitable candidates for laparoscopic inguinal hernia surgery.

  Some underlying medical conditions, that make him unfit for general anaesthesia, as usually laparoscopic surgery can only be done under general anaesthesia.

How Laparoscopic Inguinal Hernia Is Carried Out?

In a Laparoscopic Intervention, two to three small incisions are made in the lower abdominal area. The laparoscope is passed through one of these incisions and the surgical instruments are inserted through the other incisions. The abdominal cavity is inflated using Carbon Dioxide to help the surgeon visualize the lower abdominal area clearly. Using the laparoscope, the surgeon visualizes the Hernia and uses long instruments to operate on it. She covers the hernia with a mesh and may fix the mesh to abdominal muscles using either stitches or stapler-like instruments.

Benefits of Laparoscopic Surgery

1. Two or three tiny cuts (5-10 mm in size), hence there is less pain after laparoscopic surgery

2. Better cosmetic results

3. Quicker recovery

4. Early return to daily activities like walking, working, etc

5. Shorter hospital stay 

Role of Laparoscopic Surgeon In comparison to many other minimally invasive surgeries:

Laparoscopic Inguinal Hernia Repair is more demanding in terms of technical capability of the surgeon. In general, Laparoscopic Inguinal Hernia Repair is more difficult to carry out in obese people than others. However, if the doctor is well trained and technically advanced with long experience, he can carry out such minimally invasive surgeries smoothly irrespective of the BMI of the patient. Everybody is not a candidate for Laparoscopic Inguinal Hernia Repair.

It is the doctor who decides if a particular patient is suitable for such surgery or not. However, the conclusive factor in any such repair is the experience and expertise of the doctor. This is why there are not many Laparoscopic Surgeons who carry out Laparoscopic Inguinal Hernia Repairs. Owing to the complexity of this procedure, it is important to get it done from an expert surgeon only.

Laparoscopic Inguinal Hernia Repair !

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?

A hernia occurs because of an internal weakening of the abdominal layer, resulting in tearing. The inner most layer of the abdomen forms a sac and pushes the weakening area. This results in the abdomen tissue being slipped into the sac, causing pain and other health problems. It can occur to both men and women. Apart from natural weakness of the abdomen, a hernia can get triggered from heavy weight lifting, constant coughing, gaining weight and from irregular bowel movement. 80percent of hernia cases originate near the groin.

What are the symptoms?
Some of the common symptoms of a hernia include:

Constipation
Nausea
Feeling of fullness even without eating a thing
Sharp pain while lifting weight
Burning sensation
Dull ache near the groin area
Bulge near the groin area
How is a laparoscopic hernia performed?
This mode of surgery uses a telescope-like instrument known as the laparoscope. With the help of a small incision, the laparoscope is inserted at the belly button. Since the procedure is performed withanaesthesia, it isessential for a doctor to do a routine medical check-up that evaluates the general health of the patient, past medical history, EKG, blood work etc.

Usually, the patient doesn t feel a thing while the surgery is performed. A video camera is connected to the instrument to get a detailed inside view of a hernia and the area that needs to be repaired. Before this, the abdomen is inflated with the help of carbon monoxide. A mesh is placed inside the abdomen to fix the defects of the abdominal wall and strengthen the weakened tissue of the abdomen. Once the procedure is done, the incisions that are made in the abdomen is closed with the help of surgical tapes. The mark of incision disappears within a month.

Benefits of Laparoscopic Hernia Surgery
The benefits of laparoscopic surgery are quite evident.

A lot of tiny incisions are made rather than making a large incision in the abdominal area. This ensures speedy recovery and a short stay at the hospital.
The pain is significantly less compared to the conventional surgery.
The cost of a laparoscopic surgery is lesser
Lastly, a speedy recovery can ensure that a person can return to work within a few days after the surgery is performed.
What to expect after the surgery
Doctors often suggest a week of complete rest after the surgery. The healing time can vary from person to person. A surgeon typically prescribes antibiotics and pain medications to cope up with the wound and pain. It must be ensured that these medicines are taken on time. A revisit to the surgeon might be required after a couple of weeks to assess the recovery.

An Overview Of Laparoscopic Hernia Surgery!

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