Dr. Deepti Thakkar

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 a hernia. Hernias can be caused by things such as improper heavy lifting, incorrect posture, chronic constipation, multiple pregnancies and as a result of surgical complication or injury. Factors like obesity, 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: 

1. Groin hernias: 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 or femoral canal. More common in men than women. Inguinal and femoral hernias are some of the most common hernias and are most commonly treated with surgery. 
2. Hiatal hernia: The abdomen has the diaphragm separating it from the thoracic cavity in the upper border. When the stomach pushes through the diaphragm, a hernia is caused and there is almost always associated food reflux in these cases. Common causes are old age, smoking, obesity etc. 
3. Umbilical hernia: The navel is a weak point of abdominal wall. Intestines or internal fat can protrude through the navel and form umbilical hernias. Most commonly seen in babies around the bellybutton, it gradually corrects itself on its own. Also seen in adults after pregnancy or in chronic obese people. 
4. Incisional: These are post-surgical, and happen when the organ protrudes through the weakened scar of surgery. These are complex hernias as there are internal adhesions between intestines at the site of hernia and need to be treated carefully. Internal abdominal hernias can also develop which are not seen externally and patients only complain of pain. These can be diagnosed with CT scanning. 
5. Congenital Hernias: Some hernias occur from birth such as umbilical, diaphragmmatic, inguinal and need to be treated accordingly. 

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 and femoral hernias may require surgery earlier in the stage. After reducing the hernia contents, 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.

Dependent on each patient, hernias need to be managed under medical supervision. Surgery can be done Open or Laparoscopic i.e. key hole surgery. This helps reduce pain and the post surgery recovery is very fast. Patients must avoid lifting heavy weight and strenous exercise for a period of 6-8 weeks after surgery.

Are you feeling an excruciating pain in the anal region? Is there a lump around the area that you can feel? Commonly called Piles, hemorrhoids is a phenomenon where the veins are swollen in the anal canal. This is because the walls of the veins are pretty thin and pain or discomfort arises when there is too much pressure on the walls. This pressure occurs most commonly due to constipation or passage of hard stool. 

There are two kinds of Piles- internal piles and the external piles; the discomfort and severity depend on the kind of piles you are suffering from. 

Causes behind it: 

1. Constipation, i.e hard stool is the most common cause for piles. This can occur when you eat food with less fiber like junk food, breads and non-veg. Also low water intake can cause constipation. 
2. Sitting for long hours can also cause piles. 
3. Piles can also happen in the third trimester of pregnancy. 

The common symptoms associated with the condition are: 

1. Bleeding from the anus 
2. Painful lump or swelling near the anus 
3. Anal itching 
4. Tenderness or pain during bowel movements 
5. Anal discharge 

Treatment options for piles 
In few cases, the Hemorrhoids can be treated with home remedies like a change in diet, warm sitz baths, and avoiding foods that may lead to constipation. For hemorrhoids of the first and second degree, medications, home remedies and manual methods can be used. However, when the condition persists for an extended period with severe pain or bleeding, it is best to consult a surgeon. 

The piles can be treated with: 
Injection or sclerotherapy: Treats internal hemorrhoids 
Banding: Treatment for early stage hemorrhoids 
Surgery: Open surgery, stapled surgery or Laser 

Hemorrhoidectomy: This is the surgery done to remove piles. The physician performs a few minute cuts around the anus to remove them away. The area which is under operation is put under local or spinal anesthesia. 

• Recovery: Hemorrhoidectomy is often a procedure for the outpatient case, and you are typically discharged on the same day itself. The patient usually takes about two to three weeks to recover fully. 
• PPH: Another surgical method is PPH. It is also known as stapled hemorrhoidectomy. In this surgery, the surgeon uses a device which looks like a stapler to reposition the pile and struck off their supply of blood so that they eventually shrink and die out. This surgical procedure is less painful than traditional hemorrhoidectomy as it removes hemorrhoid to where there are fewer nerve endings, so it hurts less. There will be faster recovery, minor pain and slight bleeding. 

Laser for Piles- 
With the advent of laser treatment, piles treatment has become very easy, pain free and effective. Laser fiber is used to coagulate i.e. close the swollen blood vessels that form piles. This is done in an area with very few nerves so it is almost painless. It can be done under local or spinal anesthesia as a day care procedure. Patient can be discharged on the same day and can resume work after just 1 or 2 days.

What is an Appendectomy? 
An appendectomy (which is sometimes referred to ‘appendicectomy’) is the surgical removal of the organ known as the appendix. Appendectomy is mostly performed as an emergency surgical procedure, when patients suffer from appendicitis. 

How is Appendectomy Performed? 
Appendectomy can be performed both as an open operation as well as laparoscopically. Nowadays it is most commonly performed laparoscopically with small incisions to reduce pain and quicken recovery. 

Conventional Open Appendectomy- 
In the conventional open surgery, the surgeon makes an incision which is about 2.5- 3 inches in length in the lower right section of the abdomen. Once the infected appendix is identified, the surgeon separates the infected appendix from its surrounding tissues and removes it surgically from the cecum (first part of large intestine).

The muscle layers and the skin are sewn together and the incision is closed. 

Laparoscopic Appendectomy (LA)- 
While performing appendectomy laparoscopically, 2 or 3 incisions of 0.5 or 1 cm length are made in the abdomen. The surgeon then passes the camera and special laparoscopy instruments through these openings and the appendix is removed from the cecum and the site of its former attachment is sewed. The infected appendix is removed from the body. In the end, the laparoscopic instruments are removed and the incisions are sutured and closed. During this whole procedure, the intraperitoneal space is filled with medical grade carbon dioxide gas, to inflate the abdomen, which is released after the surgery. 75810

Recovery Time For Appendectomy- 
With the advent of laparoscopy, recovery is very fast and patients can be discharged on the same day. They need to avoid any heavy exercise and oily and spicy food for a few days. They can resume work in a day or two. 

Risks and complications of Appendicitis and Appendectomy 
A routine appendectomy has very few complications. As appendix is not essential for digestion, there is no change in physiology. A ruptured appendix can sometimes give high fever, pus formation and intra-abdominal infection. Hence it is essential to treat appendicitis early. In case you have a concern or query you can always consult an expert & get answers to your questions!