Healing Hands Clinic - India’s Preferred Destination for Hernia Treatment in Mohali

• A hernia may first appear as a new lump or bulge in the groin or in the abdominal area. There may be an associated dull ache but usually it is not painful on touch. The lump increases in size on standing, coughing and may be pushed back/disappear on lying down.
• A small painless hernia if left untreated, usually increases in size.
• Occasionally, the hernia may become irreducible i.e. it cannot return to the abdominal cavity on lying down or with manual pushing. At this stage it also becomes painful.
• Sometimes the loop of bowel that has herniated becomes obstructed. This can cause extreme pain, nausea, vomiting, constipation and needs immediate treatment.
• At times the hernia becomes 'strangulated' ( explained further below ) in which the person appears ill with/without fever, nausea, vomiting and extreme pain even to touch. This condition is life threatening and thus a surgical emergency.

Listed below is a concise description of some of the common hernias. Although there are other types too, they are quite rare and beyond the scope of this piece of information

• INGUINAL HERNIA
  This is the commonest type of hernia that occurs in the groin area at the top of the inner thigh. Commonly found in men, it is associated with ageing and repeated strain on the abdomen. An inguinal hernia or its repair should not be taken lightly because neglect in either of the situations can impair blood supply to the testicles, since the blood vessels that supply the testicles pass through the areas where this hernia occurs. Impaired blood supply may cause death of the testicular tissue requiring its removal.


• FEMORAL HERNIA
  Found more commonly in women, this also occurs in the groin area, just above the line separating the abdomen and the legs. A femoral hernia should not be neglected as it has high chances of strangulation, which is a medical emergency. In fact almost half of femoral hernias first come to light as emergencies. Thus femoral hernias should be repaired at the earliest, before the complications ensue.


• UMBILICAL HERNIA
  It occurs when fat or a part of the bowel bulges through the abdomen near the belly button. It is found in babies when the opening in the abdomen through which the umbilical cord passes doesn't seal properly after birth. It is also found in adults due to repeated strain on the abdomen.


• EPIGASTRIC HERNIA
  It occurs in the midline of the abdomen, in the area between the naval and the lower part of the breastbone ( sternum ). This hernia always occurs in the midline because it comes out between the two rectus muscles of the abdomen that meet in the midline. Although the lump may sometimes appear off the midline, the defect/opening is always in the midline. It may be found in infants too because of congenital weakness in the midline of the abdominal wall.


• INCISIONAL HERNIA
  It occurs at the site of a previous abdominal surgery for another cause, during which the abdominal muscles were cut open to allow the surgeon to enter the abdominal cavity to operate. Although the muscle is sutured ( stitched ) during closure, it becomes a relative area of weakness, potentially allowing abdominal organs to herniate through the incision line

Listed above is a concise description of some of the common hernias. Although there are other types too, they are quite rare and beyond the scope of this piece of information

The diagnosis of hernia is usually a clinical one, which means that your doctor will go through a history of your symptoms followed by a brief physical examination. During this check up she/he may feel the area of bulge by raising your abdominal pressure ( this is done by making you stand/cough ), as this manoeuvre makes the hernia more obvious. In case you have an inguinal hernia, the doctor will feel for the potential pathway by examining along your scrotum.To summarise, in vast majority of cases where there is an obvious swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and NO TESTS are needed. More challenging diagnoses are best performed by hernia specialists.

The treatment is based on the features of the hernia, its impact on your quality of life, and your general state of health. Treatment options may include observation, use of a supportive device, or surgery. Surgery is the only way to fix a hernia. In some cases emergency surgery is required. The treatment option that is right for you will be based on a discussion between you and your surgeon

Indications for hernia repair surgery include :

• Symptomatic Hernia: Hernia creating symptoms of discomfort, pain or interfering with activities of daily living.
• Incarcerated Hernia: Hernia trapped outside the abdominal wall and cannot be returned back inside the abdominal cavity.
• Bowel Obstruction: Hernia causing a blockage of the intestines requires surgical repair.
• Strangulated Hernia: Hernia that has compromised the blood supply of the contents. There is a high risk of death of the tissues such as intestines that are contained in the strangulated hernia. This requires emergency surgery.

A) Laparoscopic Repair
The laparoscopic repair uses small incisions on the abdominal wall through which the instruments are placed into the abdominal cavity. The abdomen is filled with air and the repair is guided by the use of a camera. The hernia contents are brought back into the abdominal cavity and a mesh is secured in place to cover the hernia defect from the inside. The mesh helps to prevent its recurrence. The laparoscopic repair has the advantages of quicker recovery, less pain, and less risk of infection.

B) 3D Mesh Hernia:
A mesh is a supporting structure used to give strength to the hernia repair. It is used to cover the defect and reduce tension in the repair. Tension, otherwise, can lead to the recurrence of the hernia.

The mesh is made of synthetic material such as polypropylene or polyester. Alternatively, the mesh may be a biologic graft derived from animal tissue. The biologic grafts are often used if there is a great concern for infection as they tend to be resistant to infections.

C) Open Repair
The open repair is the traditional approach to hernia repair surgery with an incision made over the area of the hernia. The contents are returned back into the abdominal cavity and the sac is removed. Depending on factors such as the location and the size of the hernia, a mesh is often used to cover the area of the hernia defect. Otherwise, the defect is closed with sutures.

The open approach is commonly used for very large hernias or those that are complicated by factors such as bowel obstruction, infection, incarceration, strangulation, or recurrences.

D) How to know which hernia treatment option should you choose ?
The decisions regarding the laparoscopic vs. open approach hernia repair surgery and regarding use of mesh vs. no mesh will be individualized based on the characteristics of the hernia and the discussion you have with your surgeon.