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

A hernia is a condition where fatty tissue or an organ in your body might bulge through a muscle or an abnormal opening in the body. It is caused mainly due to pressure in the muscle area or weakening in the spot. This may occur due to heavy lifting or weakness that was present since birth.

The different types of hernia are inguinal, incisional, hiatal, umbilical and femoral. For inguinal hernias, surgical methods are used. The most common method is laparoscopic repair.

What is laparoscopic hernia surgery?

In this process, you will be given general anaesthesia before the surgeon performs the surgery. Before undergoing the operation, you will have an evaluation of your complete health that will include an analysis of your past medical history and a physical examination. An electrocardiogram or ECG will also be conducted. 

Then a small cut or incision is made in the lower part of your abdomen below the navel. The laparoscope that is a small telescope-like instrument is inserted to view your internal organs. A video camera is attached to the device that projects the internal view of your body on to a screen. This is viewed by the surgeon in the operating room.

During the process, your abdomen is inflated with carbon dioxide, to create some space for the doctor to look inside easily. The inner abdomen lining called peritoneum is cut open to observe the weakness of the abdominal wall or the location of the hernia sac. After locating it, the surgeon will remove the hernia sac from the wall and use a prosthetic mesh to cover the defect. Then the small incisions are closed with surgical tapes or stitches.

Furthermore, if hernias are found on both sides, they can be operated without making a second incision. The mesh can be placed on all the abdominal areas that are weak. This prevents the hernia to occur in the same spot again or spreading to other areas.

However, laparoscopic surgery is not performed for children. It is also not suitable for some cases such as if you are pregnant, or cannot tolerate general anaesthesia or are obese. 

Aftercare

You will be able to go back home on the same day of the surgery after laparoscopic hernia repair. The recovery time lasts for about 1 to 2 weeks. After that period you can return to light activity like walking. However, you must not engage in any kind of strenuous activity like working out or lifting heavy objects.

You might observe soreness after the first 2 days of the surgery. In some cases, bruising is found in your groin area. But if you observe significant swelling in the groin region, contact the doctor immediately.

It is recommended that you maintain a diet that is rich in fibre. This is because if you suffer from constipation, the straining during your bowel movements might put pressure on the area that is repaired.

People prefer laparoscopic hernia repair as they suffer lesser pain and can get back to their normal lives faster than open repair surgeries. It is advised that you take the medications and follow the instruction of your surgeon properly after the procedure. 

 



 Laparoscopic Hernia Repair - What Should You Know?

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 !

What is a hernia?

The presence of weakness or hole in a muscle, which permits tissues and organs to bulge through the defect, is termed as a hernia. Hernias can range from harmless or barely noticeable to life-threatening, depending on the organs involved and size of a hernia. In such cases, a surgeon to counter the presence of a hernia performs a hernia repair surgery. Otherwise, it might cause substantial organ damage.

How many types of hernias are there?

A hernia can occur in any part of your body. However, it is most commonly found in the groin and stomach region. Apart from that, listed below are the different types of a hernia-

  An incisional hernia- Occurs around the incision site, due to surgery
  An umbilical hernia- Occurs close to the belly button or umbilicus
  Congenital Diaphragmatic hernia (CDH)- Occurs during birth, that might cause the internal organs to move into the chest cavity
  An inguinal hernia- Occurs in the groin region, similar to a femoral hernia
  An epigastric hernia- Occurs between the chest and belly button
  A femoral hernia- Occurs in the groin region, like an inguinal hernia
  A hiatal hernia- A hiatal hernia can cause the stomach to move into the chest cavity

A hernia can cause many problems for you, not just physically but also from other aspects as well. If you do not go for treatment at the right time, it can interfere with your day-to-day activities due to the serious pain associated with it.

What are the factors or signs that call for a hernia repair surgery?

Hernias can sometimes take a long time to notice. Many people notice the presence of a hernia when they participate in any kind of physically taxing or strenuous work. The following symptoms will help you understand whether you need a hernia repair surgery-

  Discomfort or pain that intervenes with your daily activities
  Large-sized hernias
  If your hernia is gradually growing in size and getting worse, especially in the groin region
  When your hernia starts putting a lot of pressure on your nerves, which lead to numbness and irritation
  Long-term discomfort caused due to a hernia
  Vomiting and a piercing stomach pain

The process of performing a hernia repair surgery

Hernia surgery is done in the following two ways-

  Laparoscopic surgery - During this procedure, the surgeon will inflate your stomach with harmless gas, to have a clear look inside. After this, he will make small incisions near a hernia and put a thin tube with a minute camera. This will give him get a clear view inside your stomach and allow him to repair a hernia with a mesh.

  Open surgery - In this procedure, the surgeon will make a large incision and open up your skin. After this, he will slowly push a hernia back inside, tie it and then remove it. Once this is done, the incised site will be closed up with stitches. In case the hernia is considerably large, the surgeon will use some extra mesh, to keep a hernia in its place.

Medical advancements have made it possible and quite easy to perform hernia repair surgeries, with minimal pain. Hence, if you notice even a faint sign of a hernia, make sure that you consult a doctor and get the right treatment.

Hernia Repair Surgery - What Should You Know?

Hernia, is not life threatening, but is commonly experienced by a number of people. You will experience hernia when an organ pushes through the muscles or tissues surrounding them. A hernia can occur anywhere in the body. The most common areas affected by it are the abdominal area, upper thigh, groin and belly button. In most cases, a surgery is required to treat this condition.

There are 4 common types of hernias. These are:

Inguinal hernia: This is the most common type of hernia and affects more men than women. It occurs when the intestines push through the lower abdominal wall into the inguinal canal.
Hiatal hernia:This commonly affects elderly people and occurs when the stomach pushes upwards through the diaphragm. It may also affect children if they are born with a congenital birth defect.
Umbilical hernia: This affects children and occurs when the intestine pushes through abdominal wall near the bellybutton.
Incisional hernia:This occurs after an abdominal surgery when the intestine pushes through the scar or other weak tissues.
A hernia can develop overnight or over a period of time. It can be triggered by many factors that cause weakening of muscles and strain the body.

Some of these are:

Congenital defects such as the abdominal wall failing to close properly
Age
Persistent coughing
Surgical errors or injuries
Pressure on the abdomen caused by pregnancy
Straining as a result of constipation
Collection of fluid in the abdomen
Heavy weight lifting
Excess weight gain
If anyone in your family has a hernia, you are at a high risk of suffering from one as well. Being obese and smoking can also increase your risk. Cystic fibrosis can also indirectly trigger a hernia by causing a persistent cough.Sometimes a hernia has no symptoms. A bulge in the affected area is the most common symptom of a hernia.

Some other symptoms that you may notice are:

Pain in the affected area
Weakness or pressure in the abdomen
A burning or aching sensation in the affected area
Acid reflux
Chest pain
Difficulty swallowing
If you wish to discuss about any specific problem, you can consult a doctor or ask a free question.

Things to know about 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?

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