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HERNIA – Frequently Asked Questions

1. What is hernia?
A hernia occurs when an organ squeezes through a weak spot in the muscle or tissue that holds it in its place. For example, the intestines breaking through the abdominal wall results in a hernia.
Though most common in the abdomen, they can also appear in the upper thigh, belly button or groin areas. While the condition is not by itself fatal initially, hernia will have to be treated surgically to avoid any dangerous complications that may occur at a later stage.
2. What are the different types of hernia?
The common types of hernia are
Inguinal hernia – the most common type that occur when the intestines push through the abdominal wall, in the inguinal canal. Inguinal hernia is more commonly found in men than women. This is because this hernia follows the naturally soft pathway the testicles take, to descend from the abdomen into the scrotum. The bulge may disappear when one lies on his back or exerts pressure on the groin. If the bulge does not disappear, one should consult a surgeon as soon as possible.

Umbilical hernia – These common hernias are often noted as a protrusion at the navel, a weak area on the abdominal wall. This type can also occur in babies under six months old when the intestines push through the abdominal wall near their belly button. However, this condition may rectify itself by the time the child is one year old. If this does not happen, surgery may be required to correct this condition.

Incisional hernia – This can occur after the patient has undergone any prior abdominal surgery and the intestines squeeze through the incision scar or the weak tissues surrounding it.

Hiatal hernia – A hiatal hernia occurs when part of the stomach protrudes into the chest through the diaphragm, a sheet of muscle that separates the organs in the abdomen from those in your chest. This condition is commonly found in patients over 50 years of age.

3. What causes a hernia?
Commonly caused by a combination of weak muscles and strain, hernias may develop quickly or after a prolonged period.
Muscle weakness can be the result of

• Ageing
• Chronic cough
• Damage from injury or surgery
• Congenital defect

Strain on the body can occur due to the following
• Lifting heavy weights
• Chronic cough or sneezing
• Constipation that causes strain during bowel movements
• Ascites, or fluid in the abdomen
• Sudden weight gain
• Pregnancy conditions in the case of women

4. What are the symptoms?

A bulge or a lump in the affected area is one of the common symptoms of hernia, especially that of the inguinal type. In the case of babies, the bulge can be felt only when the child is crying, providing the symptom of a possible umbilical hernia.

Some of the other symptoms of inguinal hernia can be pain or discomfort in the affected area while bending over, lifting weights or coughing. In the case of hiatal hernia, these could be chest pain, difficulty in swallowing or acid reflux, causing a burning sensation.

It is also possible that in some cases hernias do not provide any noticeable symptoms unless a routine physical or medical examination is carried out for any unrelated problems.

5. How is hernia diagnosed?

• Through physical examination by your doctor, as in the case of inguinal or incisional hernia
• In the case of hiatal hernia, an X-ray or an endoscopic procedure may be used for diagnosis
• For umbilical hernia in children, an ultrasound procedure may be performed by the doctor for diagnosis.

6. What are the treatment options available for hernia?

The best treatment option will be advised by your doctor based on the necessary clinical examination and the severity of your symptoms.
These may include dietary changes or medication, as in the case of hiatal hernia.

However, surgery is the only option to repair hernia if it is growing larger or causing pain.

7. Why hernia should be treated on time?

If hernia is not treated on time, it may grow and become more painful. It can also result in a condition where a portion of the intestine gets trapped in the abdominal wall and gets strangulated. This can lead to a life threatening situation and the patient has to be subjected to an emergency surgery. Emergency surgery under such a condition will be complex and of higher risk. So it is essential to decide on the surgery at an earlier stage.

8. Which is the best time to operate a hernia?

Hernia which disappears when one pushes it or lies on his/her back may be operated according to one’s time and convenience. But the hernia which does not disappear is dangerous. If there is abdominal pain and vomiting and if the hernia becomes red, swollen and painful, medical advice should be sought immediately.

9. What are the different types of surgeries for hernia?

Open repair (traditional method)
This involves repairing the hernia through an incision of 8-10 cm length. A synthetic mesh is used to close the wound. Barring complications, the wound will heal within a week. It will take the patient 2 – 3 weeks to return to normal life.

•    Laparoscopic mesh repair
Laparoscopic surgery uses a thin, telescope-like instrument known as an endoscope that is inserted through a small incision at the belly button. The surgery is performed observing the inside view of the patient’s body on video screens in the operating room. Special types of instruments are used for the operation. Synthetic mesh is also used here. Since the incisions are small, the pain is likely to be less.

10. What are the main benefits of laparoscopic hernia surgery?

• Comparatively less post-operative pain.
• Shorter recovery time and earlier resumption of daily activities.
• Inguinal hernias on both sides can be operated upon simultaneously through the same incision.
• Shorter hospital stay.
• Laparoscopic surgery is extremely suitable for those with recurrent hernia (return of hernia after open surgery).

11. Is laparoscopy advisable in all cases?

Almost all hernias can be repaired this way. But there are certain situations where traditional surgery is more suited:

• Patients who cannot be administered general anaesthesia
• Those who have had radiation treatment in the area of the hernia
• Those who have pus in the hernia
• Critical conditions where the intestine has got strangulated in the hernia and blood circulation has been obstructed.
• Those with very large hernias
• Those who cannot undergo major surgeries because of serious medical conditions

12. How to prepare for the surgery?

The patient should inform the doctor about the present medications he/she is taking. Cardiac patients should inform if they are using medicines like Ecosprin, Clopilet etc. Considering the age and health condition of the patient, examinations like blood test, X-ray, ECG are required before the surgery. If the surgery date is fixed in advance, the patient should get admitted the day before. Food and drink should not be consumed from midnight onwards. Even water should not be drunk on the morning of the surgery. The patient can have a bath.

13. How is the recovery after the surgery?

Only General Anaesthesia is given in laparoscopic surgery. Open surgery can be done with Spinal, Epidural or local anaesthesia.

The patient is taken to the recovery room until he/she recovers completely from the anaesthesia. Liquid food can be taken within 6-8 hours and normal diet can be resumed the same evening. Walking, going to the bath room and climbing stairs is permitted. If no specific complications are noted, the patient can be discharged the next day itself and can resume normal life within one week.

14. When should one meet the doctor after surgery?

If the patient develops a cold, fever, vomiting or has difficulty in urination, or if there is oozing from the incision, he/she should inform the doctor immediately. If there are no such issues, a visit to the doctor after 7-10 days should suffice.

15. What are the complications of Laparoscopic surgery?

There may be bleeding, pus in the wound or pus in the mesh area as in any surgery. In very rare cases, it may not be possible to complete the surgery through laparoscopy. In a few cases, the urinary bladder, intestine or blood vessels in the area may get injured. Though utmost care is taken in surgery, hernia can recur in 1% of the patients.
But, today, as laparoscopic surgery is very advanced, such cases are extremely rare.

16. Can hernia be prevented?

While it may not always be possible to prevent the muscle weakness that allows hernia to occur, certain precautions can be adopted to keep an existing condition getting worse. These include

• Maintain a healthy body weight
• Avoid lifting heavy weights and use the back for the same
• Do not allow a persistent cough untreated
• Avoid straining during bowel movements