Hernia are bulges protruding form a weak point on belly (abdomen) through which intestine and abdominal fat comes out to lie just below the skin. It can also be found in groin, upper thigh and chest. There are several types of hernia like inguinal hernia (direct and indirect), femoral hernia, umbilical hernia, umbilical hernia, epigastria hernia and incision hernia.

Who get hernia?

Conditions that lead to increased abdominal pressure are at more risk of developing hernia  

o Persistent cough

o Being overweight or pregnant

o Lifting, carrying or pushing heavy loads

o Straining on the toilet

What are the symptoms of hernia?

o Mostly they are asymptomatic/ no symptoms.

o People just notice a swelling or bulge which gets bigger while standing or straining and disappear while lying down/sleeping.

o Some might feel a dragging/aching sensation.

o The swelling tends to get bigger with time.

o Symptoms develop when there is a complication like strangulation. This happens when the content of abdomen (intestine) come out and can not go back. There will be severe pain in the region and vomiting. Overlying skin will become red. Urgent surgery is needed in this situation otherwise the blood supply to intestine gets cut-off and the intestine in hernia might die (gangrene).

How are hernia treated?

Surgery is the only treatment for hernia. Now a days, most of the hernias are operated laparoscopically (key hole or minimally access technique)

Minimally Invasive Hernia Repair - The surgery is done with a laparoscope which has a small tiny camera, hernia mesh and small tool with it. So the patient can return back to their normal routine earlier as the incision made is smaller.

Advantages of Laparoscopy:

Laparoscopy has clear advantage over open repair in the way of less pain, less complications like wound infection, small and more cosmetic scar, shorter hospital stay, early return to work and daily activities and less chance of recurrence (repeat formation of hernia after surgery).

Before undergoing hernia surgery:

* One week before surgery it is much essential to stop taking drugs that are causing the thinning of the blood. Drugs like Clpodogrel and Acitrome or Warfarin should be stopped with the doctor s advice. 
* Stop herbal supplements and check the fitness of your cardio and diabetes. 
* Gain adequate knowledge about surgery and be prepared for post surgical care.

After hernia surgery:

* Avoid heavy weight lifting, exercises, and physical works with excessive strain a few weeks after surgery 
* Cough or laugh loud only with support to the surgical site until one week after surgery

DO s & DON T s in patients of Hernia:

DO s:

1. Increased intake of fibers in diet. ( Fruits, vegetables and grains)

2. Drink plenty of water and other fluid to prevent constipation.

3. Exercise regularly: sweat and loose excess weight and toxins.

4. Eat small meals more frequently in place of one or two large meals

DON T s:

1. Stop smoking and drinking

2. Don t reduce the amount of food you eat

3. Avoid lying down or bending after meal

4. Avoid wearing tight clothes

5. Avoid food difficult to digest

6. Avoid strenuous activities like heavy weight lifting

Types of Hernias:

Incisional hernia:

This happens at the site of previous surgery. This occurs as a result of poor wound healing at the time of previous surgery or as a result of complications like in infection. It is rare after laparoscopic or key hole surgery.

Umbilical hernia:

This occurs through or around belly button (umbilicus). It can be present at the time of birth and needs no repair as most of them resolve by the end of one year. If it persists or appears after 5 years of age then operation is required.

Inguinal hernia:

These are most common hernias and occur in groin region. They are more common in men.

All You Need To Know About Hernia!

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?

When an organ or fatty tissue is squeezed through a hole (weak spot) in the connective tissue or a surrounding muscle then it causes a hernia. Usually, hernia happens at the abdominal wall and sometimes it can be seen as an external bulge.

There are various types of hernia which include:

  Inguinal Hernia (happens in the inner groin).
  Incisional Hernia (develops through a scar or an incision in the abdomen).
  Umbilical Hernia (develops at the belly button).
  Femoral Hernia (develops in the outer groin or upper thigh area).
  Ventral Hernia (develops in the general ventral or abdominal wall).
  Hiatal Hernia (develops inside the abdomen, beside the upper diaphragm or stomach).

The most common cause of hernia is the combination of pressure and opening of connective tissue or weakness of the muscle. Anything that escalates the abdominal pressure can lead to a hernia, including lifting heavy weights, constipation, persistent sneezing or coughing, obesity, and diarrhea. Overexertion, poor nutrition, and smoking can also weaken the muscles and can increase the possibility of a hernia.

Mesh Surgery 
Surgical mesh is used to supply extra support to the damaged or weakened tissue. It is a medical device, usually made out of either animal tissue (from skin or intestine) or synthetic material. Surgical mesh of synthetic material can be made in non-knitted sheet forms or in the knitted mesh. The synthetic material used for making a surgical mesh can be absorbable, non-absorbable material, or a combination of both.

Surgical mesh made out of animal tissue is disinfected and processed in a way that makes it suitable for implantation. These are absorbable and mostly made from the tissues of pig or cow.
Absorbable mesh degrades and loses its strength over time. It is not made to supply
long-term support to the restored site.

On the other hand, non absorbable mesh remains in the body for a long duration and is accounted for as a permanent implant. It provides permanent strength for restoring hernia.

In Hernioplasty or the mesh surgery for a hernia, the muscle opening is not stitched shut, instead it is covered with a sterile, flat mesh which is mostly made of synthetic or animal tissue. Small cuts are made around the hole in the shape of the mesh and the patch is stitched into the healthy surrounding tissues. The weak or damaged tissues around the hernia use the mesh, as support to regrow.

Recovery
Usually it takes up to 4 to 6 weeks to recover completely from mesh surgery. However, one can get back to his/her normal routine within 2 weeks post the surgery. There are certain precautions that one should undertake to avoid any complications. One should avoid heavy weight lifting, heavy exercises, stretching, and running. These precautions include diet modifications too. One should avoid consuming heavy fatty food and meat.

Takeaway
A hernia can be caused by a number of reasons and mesh surgery is a medical procedure helps to treat this problem. One should not avoid the treatment of hernia as the early treatment reduces the complications.

Mesh Surgery For Hernia - All You Must 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?

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

You will definitely face many complications after a hernia surgery, but certain measures can lead you to a speedy recovery. Your main aim must be to ensure you don t get any infection. Avoid any jerking like sneezing or coughing. Some of the tips for speedy recovery are mentioned below:

Apply ice to reduce pain: If you experience any form of swelling or pain, ice will help reduce it. Apply ice for 10-20 minutes in a day, and you will get your results. However, refrain from applying ice for too long. It might make the condition worse. Also, wrap up the ice in plastic or a piece of cloth and then apply it to the intended portion.
Take regular medication: Patients experience fever and pain after a hernia surgery. To combat these, you can take prescribed medications from your doctor. Medications also aim in improving your immunity so that you do not get infections easily. Hence, the medications are not to be missed.
Keep your wounds clean: The operated area must always be kept clean to prevent any form of infection. You must dress the wound daily and keep the incision points clean and dry. Change the dressing as your doctor has advised you to do. You can apply any antiseptic or any other cream but take your doctor s permission first.
Keep a pillow near you: When you get an urge to sneeze or an urge to a cough, just cover your incision with the pillow and do it.
Maintain a proper diet: A proper diet plays a significant role in the recovery process. Consume fruits to replenish your storehouse of nutrients. Include high-fiber food in your diet so that you don t have to suffer from constipation. You need to avoid constipation as much as you can. If food doesn t work, you can take stool softeners. Constipation will lead to extra pressure on the cuts which can lead to bleeding.
Wear loose clothing: Don t wear tight pants or clothing that will stick to your skin. The waistbands must be loose and not tight.
Avoid lifting weights: Don t lift weights. Lifting weights will cause stress at the cuts and may even lead to rupture so avoid doing strenuous activities.
Go for a small walk: As soon as you feel a bit better go for a little walk. You need to move your muscles otherwise they will become stiff.
Don t smoke: Avoid smoking after the surgery as it will hamper your breathing and circulation process.
Check out for warning signs: Always keep an eye on your wounds. Report to your doctor as soon as you see bleeding or anything abnormal.
Follow the tips mentioned above, and you will see how fast you will recover.

Hernia Surgery - 10 Effective Tips For Speedy Recovery!

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