DEPARTMENTS

Hernia Surgery

Hernia is a condition where an organ or a part of an organ protrudes through a normal or abnormal opening, causing pain and other serious problems.

Common example is a swelling at the Umbilicus (neural), which is nothing but fat or intestines bulging out of a hole at the neural. This can cause a swelling pain or even a life threatening condition.

 

If the intestine gets stuck inside, and its blood supply gets hamperedor obstructed . There are more than fifty different kinds of hernias described, but let us look at the common hernias and a few rarely occurring hernias.
Common hernias :
  1. Inguinal Hernia
  2. Umbilical Hernia
  3. Incisional Hernia
  4. Hiatus Hernia
Inguinal Hernia:
Relevant Anatomy :

Inguinal canal is situated in the lower abdomen on both sides, it begins at the internal ring and ends at external ring close to midline above serotum. This canal transmits blood vessels and Vas deferens going to tests.

In women, it transmits the round ligament of uterus.

Understanding Genesis of Inguinal Hernia:
Clinical features of Inguinal Hernia:
Symptoms :
Treatment :
Although small direct Hernias and a small percentage of asymptomatic Hernias can be observed or, majority of Hernias need to undergo surgery.
Surgery for Inguinal Hernia
Surgical repair of Inguinal hernia can be done by open surgery or Laparoscopically, which is a form of Telescopic surgery.
Open Surgery
Although many different types of surgeries are done for Inguinal Hernia, the commonly done types are –
  1. Liechtenstein Repair which is the gold standard now.
  2. Shouldice Repair
Symptoms :
Shouldice Repair:
Open Surgery

First Laparoscopic Repair in the world was done by surgery Arregui in 1991, and Laparoscopic repair of Inguinal Hernia started in India by 1995.

Laparoscopic repair of Inguinal Hernia an be done in two days

Advantages of Laparoscopic Repair:
Disadvantage of Laparoscopic Repair:
Although most seromas disappear with passing time, few may need aspiration with syringe.
Procedure TAPP:
Types of Mesh Used:
  1. Polyprolene heavy weight / normal weight
  2. Polypolene light weight
  3. Polyester meshes?
  4. Large pore mesh
  5. Composite, partially absorbable meshes.
  6. 3-D meshes which fit the shape of inguinal region.
  7. Self fixing meshes , which do not need any fixing sutures or screws.
Types of fixation devices:
  1. Metal Tackers
  2. Absorbable tackers
  3. Glue
Postoperative Complications:

The causes can be many

  • Nerve injury
  • Meshalgia
  • Testicular pain
  • Pain due to tackers
  • Ostestis pubis

Management is complex and multifactorial.

  • This can manifact is pain, swelling and fever.
  • Sometimes discharging sinuses
  • This is rare but dreaded complication
  • Removal of mesh is necessary in almost all patients.
TEP Repair :
Umbilical Hernia:

The umbilicus is the place in the abdomen, and hence Hernias can develop. Especially pregnancy and obesity can stretch the abdominal wall and cause a defect at umbilicus, since it is not covered by any muscles.

It is through this defect that omentum (abdominal fat) or intestines can protrude and later on get stuck inside the hernia.

This hernia also goes on progressively enlarging. TN some cases the skin can be stretched , it can become dangerously thin and can break down, causing a wound (ulcer) on the hernia.

Umbilical Hernias can also poccur is patients having fluid (Ascitis) in abdomen.

Hernias can develop near or next to umbilicus when they are called as paraumbilical Hernia. The treatment is similar to umbilical hernia.

Umbilicus is the weakest part of abdominal wall. This small area is not covered by any muscles. A small hole (defect) can develop at umbilicus, either as a result of congenital ( birth defect) cause or it may occur due to stretching as happens in pregnancy or fluid accumulation due to disease process.

Fat (omentum) or intestine state protruding out through this defect.

Slowly the defect enlarges and the fat or intestine gets stuck inside the cavity.

Occasionally it cause an emergency if the part of intestine stuck inside gets obstructed and its blood supply gets hampered. This will need emergency surgery.

Causes of Umbilical Hernia
Clinical features:
Surgery for Umbilical Hernia:
Laparoscopic Repair:
Complication :
Incisional Hernia:

This Hernia occurs through a single or multiple gaps in the scar of previous surgery. This happens due to one or multiple factors. Lack of adequate healing, increased pressure on wound in early days, infection of stitches, or rarely improper technique of closure can result in incisional Hernia.

The fat (omentum) or intestines starts from protruding out of these defects and slowly enlarges in size. Overtime it gets stuck inside the sac.

Like umbilical Hernia, this also can get obstructed or if blood supply in hampered the part of intestine can die and present as Gangrene.

Surgery can be done by open or Laparoscopic technique, very similar to umbilical Hernia.

However,Incisional Hernias are more difficult to tackle since

Laparoscopic Repair :
Hiatus Hernia :

The valve between the food pipe and stomach prevents acid and food into reregargitating upwards into food pipe. This valve is situated just below the diaphragmatic opening inside the abdomen.

If this valve migrates upwards into the chest, carrying a small part of stomach, it looses its ability to remain closed, and thus remains open. This condition is called Hiatus hernia of Sliding type. This will cause acid and food to regurgitate into food pipe, especially on lying down or at night.

Symptoms are :

The other type of Hiatus Hernia is when the valve remains in the abdomen, but a part of stomach migrates up into the chest. This is called Paraoesophageal Hernia. This can cause chest pain after eating occasionally a large part of stomach can migrate into chest. This can suddenly undergo a twist ( volvulus) and cause severe pain and requires emergency surgery.

Diagnosis is done by :
Treatment consists of :
Surgery- Nissen’s Fundoplication
Surgery is done Laparoscopically :
Complications :
Paraoesophageal Hernia :
Laparoscopic Repair :