Hernia

Hernia is a an abnormal protusion of a viscus or a part of Viscus through an opening artificial or natural with a sac covering it

Hernia is an area of a weakness or disruption of fibromuscular tissue of the body

There are different kinds o hernias ,each requiring specific management.

Depends upon site different kind of hernias are following

  • Inguinal Hernia: Presnet in lower abdomen in inguinal region and in male may be goes down up to base of scrotum.
  • Femoral Hernia: It is also present in lower abdomen in inguinal region but originate below inguinal ligament.
  • Epigastric Hernia: In midline of abdomen above umbilicus(between xiphisternum and umbilicus)
  • Paraumbilical Hernia: In the region of umbilicus from one part of circumference of umbilicus
  • Umbilical Hernia: In the region of umbilicus from Whole part of circumference of umbilicus.
  • Incisional Hernia: Anywhere in abdomen from previous scar mark.
  • Lumber : From outer flanks of abdomen.

Causes of hernia

  • straining
  • lifting of heavy weight
  • chronic constipation
  • urinary causes: very young age: Phimosis and meatal stenosis Younger age: Stricture Urethra Old age: BPH. Prostatic carcinoma
  • Obesity , smoking and ascites
  • Pregnancy and pelvic anatomy(Femoral Hernia in Female)
  • Appendisectomy(Direct Inguinal Hernia)
  • Congenital preformed sac (indirect inguinal hernia)
  • Familial Causea: Collagen disorders

SYMPTOMS

  • Swelling:Hernias present as swelling in respective region which may reduce (in case of reducible hernia) or may not be reduce (in case of irreducible hernia)
  • Pain swlling may be associated with dull aching pain but there may be severe pain in case of irreducible and obstructed hernia
  • Nausea , vomiting , fever , constipation may occur in obstructed and strangulated hernia.

DIAGNOSIS

Imaging is principle means of detecting internal diapharagmatic and other non palpable or unsuspected hernias.

Multidetector CT(MDCT) can show with precision the anatomic site of hernia sac, and the content of the sac and any complications.

MDCT also offers clean details of abdominal walls allowing wall of hernias to be identified accurately.

TRETMENT

Surgery is usually recommended for most type of hernias to prevent complications like

Obstruction of bowel or strangulation of tissue

1. OPEN SURGERY: Uncomplicated Hernia are principally repair by Reducing the herniated tissue and then repairing the weakness in Muscle Tissue( Herniorraphy)

Muscle reinforcement technique involve placement of synthetic materials over defect (Herniplasty)

The mesh is placed either over defect (Anterior Defect)or under the Defect(Posterior defect)

In complicated hernia the surgeon check the viability of herniated organ and resect ii if necessary

2. Laproscopic Hernia Repair: The Minimal Invasive surgery

That commonly used today via 3 to 4 small keyhole laproscope and instruments, in laproscopic repair surgical mesh is placed over defect over defect from Inside the

Abdominal cavity

Following Techniques can be used for laproscopic hernia repair

  • TAPP Repair( Trans abdominal pre peritoneal laproscopic mesh repair)
  • TEP ( Totally Extra Peritonial Laproscopic Mesh Repair)

Post operative recovery is fast and patients is discharged on the same day or after 1 night hospital stay. Patient resumes his duties earlier

Pt also experience lesser pain and lesser amount of analgesic in laproscopic hernia repair as compare to open surgery.