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!

A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part of therapy for cancer. You should have a clear understanding of your reason for this surgery.

How is this done?

The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.

There are three ways to remove the uterus:

Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen. 
Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15 20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.
What are the risks of undergoing this procedure?

Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have. 
Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
Infection in the operation site, pelvis or urinary tract.
Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
Things to do before you come to the hospital

It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old

You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.

You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified

At midnight if your procedure is in the morning

At 6 am if your procedure is in the afternoon.

You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.

Please remove all body jewelry.

After your surgery

When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.

Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.

Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.

You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.

If you have pain or nausea, please tell your nurse. Effective pain management is important.

You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.

Recovering at home

What to expect

You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal

You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night

You may feel fatigued

You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer

After the operation, you will no longer have a period

For the majority of women, hysterectomy surgery does not have a negative effect on sexual function

What to avoid

For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.

It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.

Avoid sexual intercourse for six weeks to allow healing to take place.

Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).

It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.

Contact your doctor if you develop any of the following complications:

Your wound becomes red or inflamed, painful.

You have heavy vaginal bleeding heavier than a normal period.

You have offensive vaginal discharge.

You develop a fever i.e. temperature of about 38  C, or you are feeling unwell.

You have pain that is not relieved by simple analgesia.

You are having difficulty passing urine or opening your bowels.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Surgery For Womb Removal - What You Need To Be Aware Of?

Kidney transplantation is a major surgery. In this surgery, doctors will remove your damaged/malfunctioning kidney and replace it with a healthy kidney from a donor. A successful kidney transplantation surgery will greatly increase your life expectancy if doctors have diagnosed you with chronic kidney disease.

However, some kidney transplantation surgeries have a better outcome than others do. This is mainly due to some factors that can affect the chances of success before and after the surgery. Here is a look at what these factors are.

Pre-surgery:

You may not be able to control what happens before the transplantation surgery, but here are some things that can affect your chances of a healthy life:

1. Age of the donor and the recipient: Younger people have healthier bodies and easily recover from surgery. Therefore, to achieve the best results in kidney transplantation surgery, it is important for the kidney donor to be young. Kidneys from a younger donor are likely to be healthier and function better for a longer time. For instance, if donor A is 60 years old and donor B is 30 years old, the outcome of transplant will be better if you receive the kidney from donor B. Similarly, if you are too old, your body may reject the transplanted kidney. However, your body will easily adjust to the transplant if you are young.

2. Living donors are better: If you receive a kidney from a living donor, the surgery is much more likely to be successful. In most cases of living donors, a friend or family member donates the kidney to the patient. Therefore, if you have a friend or relative willing to donate a kidney to you, you should opt for that instead of waiting for a kidney from a dead donor.

Post-surgery:

When you undergo a kidney transplant, you can develop heart diseases. Here are some things that will help you prevent that-

1. Keep blood pressure low

Some medications for your kidney disease can lead to an increase in blood pressure. Therefore, you should consult the doctor and report the elevated blood pressure, so that he/she can change the medicine. Additional medication may be required to keep your blood pressure under check so that you do not develop cardiac conditions.

2. Keep cholesterol levels in check:

To prevent organ rejection after the transplant surgery, doctors prescribe immunosuppressants. These drugs can increase cholesterol levels in the blood, which leads to blood and heart disorders. Therefore, you need to reduce cholesterol intake through diet. Ask your doctor about exercises that you can do to reduce cholesterol build up in the body.

Lastly, maintaining proper body weight is also essential after kidney transplantation surgery. Taking these measures will keep your overall body healthy while keeping heart disease and other problems at bay.

How To Achieve Best Results In Kidney Transplantation?

What menstrual problems are to women, prostate problems are to men. The prostate is a gland in the lower abdomen that aids in the production of semen. The prostate is walnut sized in a young man, but can get enlarged with age. As it grows bigger, it can cause a number of problems. These are commonly seen after a man celebrates his 50th birthday.

There are three common prostate problems faced by men. Some of the symptoms that can tell if a man has a prostate problem are:

1. Difficulty faced while urinating
2. The urge to urinate frequently at night
3. Constant feeling of a full bladder
4. Pain while urinating
5. Blood in the urine

Prostatitis

This can be defined as inflammation of the prostate gland. In most cases the cause of this inflammation is unknown. However, there are two types of prostatitis; bacterial and nonbacterial. While the former reacts well to antibiotics, the latter is more difficult to control. Symptoms of this disease vary from one person to the next. Some of the factors that could trigger this disease are:

1. Chemical irritants
2. Past bacterial infection
3. Dysfunctional pelvic floor muscles
4. Sexual abuse
5. Chronic anxiety

Enlarged prostate

As mentioned earlier, as men get older, the prostate gland tends to grow in size. This growth is benign, but can block the bladder neck and prostatic urethra. This can cause problems urinating and lead to acute urinary retention. This can be very painful. Inserting a catheter can provide temporary relief and help release stored urine. Chronic retention is much less common and is associated with high bladder pressure and can damage the kidneys.

Prostate cancer

Advancing age and family genetic history are said to be the main triggers of prostate cancer. This type of cancer can remain restricted to the prostate gland in its early stages but may spread to the other glands as the cancer advances. This can also cause the growth of secondary tumors in the bones.

The only way to correctly diagnose a prostate problem is with a thorough physical examination. This includes a digital rectal exam where the doctor will insert a gloved finger into your rectum to check the size of your prostate, a blood test, mid stream urine tests and ultrasounds. In some cases a biopsy of the prostate may also be required. Depending on the diagnosis, your doctor may prescribe antibiotics, surgery, radiotherapy or hormone therapy to manage your prostate.

Are You at Risk of a Prostate Disease?

Menorrhagia refers to very heavy and prolonged menstrual bleeding or periods in women. The bleeding is abnormal in nature, and if this continues for a long time, a hysterectomy surgery needs to be carried out to solve the problem.

Bleeding during the night time and passage of large blood clots during menstruation are other symptoms of Menorrhagia.

Causes:

The various possible causes of this kind of heavy menstrual bleeding are:

Hormonal imbalance, specifically of estrogen and progesterone is a common cause, which is more likely in adolescents and in women nearing menopause. Dysfunction in the ovaries also causes hormonal imbalance.

Non-cancerous tumors or fibroids may also be responsible for menorrhagia.

Women suffering from a miscarriage or ectopic pregnancy are likely to experience heavy menstrual bleeding.

Using blood thinners may lead to menorrhagia.

An intrauterine device used for birth control measures can cause disturbance and may lead to heavy menstruation.

A condition known as adenomyosis, where the glands in the uterus lining get embedded in the walls of the uterus, also causes menorrhagia.

Pelvic inflammatory diseases, infection in the uterus or fallopian tubes are other common causes.

Heavy bleeding may occur in patients with ovarian or cervical cancer.

Diseases of the kidney, liver or thyroid diseases may also cause menorrhagia.

Diagnostic Tests:

Several tests and methods are carried out for the diagnosis of menorrhagia. They are:

A general physical examination.

Bleeding diary of the woman.

Blood tests to detect anemia or thyroid.

Pap Smear for the evaluation of cervical inflammation, infections or cancer

Ultrasound for evaluation of pelvic organs like uterus, ovaries and pelvis.

Hysteroscopy, where a camera is inserted into the uterus to observe the linings.

Sonohysterography, where a fluid gets instilled into the uterus along with an ultrasound test.

Treatment:

Certain drugs are used to treat menorrhagia. They include:

Iron supplements for treating anemia.

NSAIDS or non-steroidal anti-inflammatories for treating and reducing blood loss.

Tranexamic acid is used for reducing menstrual bleeding.

Several oral contraceptives are used for regulation of the menstrual cycle. Oral progesterone corrects hormonal imbalance and reduces bleeding.

Surgical procedures for treatment of menorrhagia include:

Hysteroscopy, dilation and curettage, where uterus lining is scraped and evaluated.

Uterine artery embolization treats menorrhagia with fibroids.

Focused ultrasound ablation enables the killing of the fibroid tissue.

Myomectomy, endometrial ablation and endometrial resection are other surgical techniques.

Hysterectomy surgery is the penultimate solution, where the uterus, cervix or ovaries are completely removed.

Menorrhagia is characterized by abnormally heavy menstrual bleeding in women. This is quite unhealthy and proper measures must be taken for curing the heavy bleeding.

Menorrhagia (Heavy Menstrual Periods) - A Common Indication For Hysterectomy

Obesity can make life miserable. From unhealthy eating habits to unhealthy lifestyles and medical conditions, obesity can be an amalgamation of many factors. Obese people are a greater risk of suffering from many serious health complications like type-2 diabetes, mood swings, and depression, cardiac problems, high blood pressure and high cholesterol, to name a few. It does not stop there. More alarming is the fact that obese people are an increased risk of suffering from different types of cancer.

Bariatric surgery comes as a saviour for highly obese people (with a BMI over 40), who have tried every possible treatment under the sun to lose weight without any success. Bariatric surgery has helped many severely obese people attain a healthy weight. Bariatric surgery can be of three types;

Gastric bypass surgery (Roux-en-Y): This is one of the most common types of weight-loss surgery practised worldwide. The procedure involves rearranging (dividing) the stomach into a smaller upper pouch and a larger lower part. The smaller pouch is then connected to the small intestine. The food consumed will pass into the small intestine through the pouch. The idea is to rearrange the stomach in such a way that a person consumes a lesser quantity of food.
Gastric banding (Laparoscopic Adjustable Gastric Band): In this procedure, the surgeon creates a small pouch at the upper part of the stomach by placing a band (lap band or A-band) around it. The pouch, true to its name, is used to hold the food consumed. The purpose of placing a band around the stomach (upper part) is to reduce the intake of food.
Sleeve Gastrectomy (Gastric Sleeve surgery): In Sleeve Gastrectomy, surgeons remove a large portion of the stomach, leaving behind only a small sleeve-like pouch (hence the name). Like the other two surgeries, sleeve gastrectomy also aids in limiting the consumption of food.
Duodenal switch: The fourth type of bariatric surgery, Duodenal switch with biliopancreatic diversion, is not very commonly used. Bariatric surgery has several health benefits. In addition to the weight loss, it plays a pivotal role in lowering the incidences of Type-2 Diabetes, depression, anxiety, coronary artery problems, sleep apnea cardiovascular diseases.
Research also suggest that bariatric surgery has been instrumental in reducing the chances of cancer (especially colon and breast cancer) by as much as 60%. The correlation between weight loss and reduced cancer instances is still a debatable topic. Some researchers and oncologists believe that the weight loss (bariatric surgery) brings about a hormonal modification which prevents the growth of tumour cells. Another study links obesity with an increased inflammation. In many cases, inflammation acts as a catalyst, accelerating the growth of cancer cells. Research is still going on to understand this correlation (obesity and reduced cancer rates) better.

Bariatric surgery has its share of risks and demerits. Consult your physician and get yourself thoroughly examined before opting for the surgery.

Does Bariatric Surgery Reduces The Risk Of Cancer?

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