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Navjeevan Hospital

Consultant Surgeon

About Hernia

Symptoms of Hernia

FAQ   

Case Studies

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What is Hernia
Hernia occur
Types of Hernia
Risk Factors
Precaution
Surgical operation
Treatment of Hernia
Does a mesh help
What is PHS ?
Anaesthesia
Important requirements
Success Rate
Do's and Don'ts
Ambulatory Hernia surgery
Groin Hernia
Abdominal Hernia

ABOUT HERNIA

Hernia is a very common disorder and affects about 2% of the population; hence it is important for all to have basic knowledge of this problem, its symptoms and treatment.

It can occur in males as well as females but it is more common in males. Hernia can occur at any age, from cradle to grave; it may be seen in a newborn child as also in a very old person. Every Hernia needs immediate detection by medical expert, proper and detailed diagnosis followed by proper treatment.

Hernia occurs mainly through abdominal wall.

External Hernia can usually be observed on abdominal wall while Internal Hernia occur within the abdomen and can't be seen on abdominal wall.

Definition :

It is a protrusion of Intestine / Abdominal fat ( Omentum ) / urinary bladder, commonly through an abnormal or abnormally large normal opening in the muscle wall of the abdomen. Seen as a Swelling, which may not be painful all the time. Swelling appears on straining and coughing and may disappear on lying down.

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What is Hernia :

Patient suffering from hernia gets abnormal swelling due to protrusion of abdominal content, mostly small or large intestine, abdominal fat called omentum or sometimes urinary bladder in older people. This protrusion occurs through an opening or weakness in muscle wall of the abdomen. Hernia can be reducible or irreducible; it may disappear if reducible and reappear in erect position or on straining and coughing. Reduction may be spontaneous i.e. content of the Hernial sac may return unaided to the abdominal cavity when patient lies flat on his back. However if the patient remains untreated a reducible Hernia may become irreducible i.e. content of the sac does not return to the abdominal cavity. Irreducibility may be caused by the increase in the size of the Hernia, formation of adhesions or relatively tight Hernia ring (defect in the wall of the abdomen). Irreducible Hernia is a constant source of danger, as it may result into obstruction or strangulation. Such Hernia needs immediate surgical operation.

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Where does Hernia occur on the abdominal wall:

Hernia can occur at various sites on the abdomen. The commonest sites in 90% cases is groin i.e. lowest part of the abdomen, just above the thigh on the right or the left or both the sides. It is more common in male, the ratio between males and females being as high as 25:1.

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Various types of Hernia :

  • Inguinal (Groin) Hernia. Most common as mentioned earlier.
  • Umbilical (Navel) Hernia.
  • Paraumbilical Hernia Around umbilicus.
  • Incisional Hernia Occurs at the site of previous operation which has failed to heal properly: more common in females.
  • Epigastric Hernia In the upper part of abdomen.
  • Ventral Hernia In the lower front part.
  • Femoral Hernia Below the groin fold.
  • Spigelian Hernia Rare.
  • Hiatus Hernia Internal Hernia.
  • Lumbar Hernia Rare.
  • Obturator Hernia Rare.

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Risk Factors :

  • Hereditary genetic factor.
  • Chronic cough and sneezing.
  • Tuberculosis.
  • Chronic constipation.
  • Enlarged prostate.
  • Obesity.
  • Liver diseases like cirrhosis of liver.
  • Protein malnutrition.
  • Lifting heavy weights.
  • Heavy smoking increases chances of developing Hernia.
  • People with polio or paralysis affecting lower limb are prone to develop Hernia due to weakness of muscles.
  • Weakness of the muscle due to old age.
  • Post-operative wound infection in an operated patient with poor muscle healing resulting into weakness of abdominal wall & hernia.
  • Occasionally after appendix operation,due to damage to the nerves in the region.
  • Certain yogic exercises or aerobics. However, cycling or kicking bike paddle doesn't cause Hernia.

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Precaution when hernia swelling is observed :

  • Avoid lifting heavy weight.
  • Avoid strain in any respect.
  • Avoid heavy exercise.
  • Avoid standing for a long time.
  • Treat cough and cold immediately.
  • Smoker should stop smoking.
  • Do not delay consultation of expert Hernia surgeon.
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    Is surgical operation mandatory :

    Yes, it is mandatory. For treatment of Hernia, surgery is the only remedy. There was never, there isn't, and there may not be in future any treatment for Hernia other than surgical operation. Delay in operation can result into enlargement of Hernia or may cause complication like obstruction or strangulation resulting into gangrene of a part of the intestine, which is a life - threatening condition.

     

    Who can be operated :

    Operation can be performed at any age from newly born child to a centurion i.e. person as old as 100 years.

    The author has on record several patients above the age of 90 yrs who have been operated for Hernia and returned home on the same day.

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    Treatment of Hernia :

    There wasn't, there isn't & there may not be any treatment of Hernia except Surgical Operation of Repair.

    Various Methods of Repair are

  • Tissue Repair ( without using mesh )
  • Hernial sac is removed and the gap is closed by approximation of muscle in the region(conjoint tendon)to the inguinal ligament.Various methods like Bassini's,Shouldice's repair aer well known recurrence rate is slightly higher then mesh repair.

  • Mesh Repair
    • Flat Mesh :
      Light weight mesh
      Composit light weight mesh
      Flat PTFE mesh.
    1. (a). Flat PROLENE Mesh

       

      (b). Flat PTFE Mesh
      (c). Flat VYPRO Mesh
    2. PHS Mesh : Two layered , three dimensional mesh.
    3. Kugal Mesh.

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    How does a mesh help ?

    It provides a physical barrier to the intestines and abdominal fat preventing the same from protruding. Body tissues grow through the mesh and allow the fixation of the mesh to the surrounding area, thereby preventing the recurrence of the Hernia.

    If the mesh is not properly fixed in its position it may lead to recurrence of Hernia. This type of surgery should be performed in an operation theatre having most aseptic atmosphere to avoid the chances of infection and hence the recurrence of Hernia.

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    What is PHS ?

    It is a dual mesh joined to each other by a connector, and is made up of prolene ( Polypropylene), hence named the Prolene Hernia System (PHS). It was designed by American Surgeon Dr.Arthur Gilbert of South Miami Hospital , Florida , USA . The operation of Hernia using PHS was first described by Dr. Arthur Gilbert.

    It is technically an excellent mesh and has the following indications for its use:

    • Old age patients,
    • Patients with risk factors,(refer to risk factors)
    • Weak patients,
    • Persons engaged in strenuous work,
    • Obese persons,
    • Immuno compromised patients and
    • Patients having large Hernia.

    PHS provides comprehensive repair for Indirect, Direct, Femoral & Lateral triangle Hernias. It is also used for umbilical, paraumbilical, small incisional and epigastric Hernias. The recovery after the use of this mesh is excellent and with negligible post operative pain.

    In our clinic most of the groin Hernia & small type other hernias are operated under local anesthesia.

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    What anesthesia is administered for Hernia operation ?

    Most of the cases are operated under local anesthesia. It is very safe and generally without any complication. Patients are comfortable during the surgery and are found talking with the surgeon while the surgery is in progress. On completion of the surgery patient gets up from the operation table and starts walking on his own.

    There are no side effects like nausea or vomiting, which allows the patient to resume his diet immediately with tea/snacks and followed by regular meals.

    This technique is also safe for cardiac patients and other high-risk patients. Old age patients are safely operated under local anesthesia & are able to return home the same day.

     

    Patient comes out of Operation Theatre Walking and is having tea soon after. He is 92yrs. of age

     

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    Important requirements in Hernia Operations

    • Technology
      Excellent operation theatre facilities with modern equipments, maintaining sterile atmosphere in the operation theatre.
    • Technique
      Selecting appropriate technique of operation by the surgeon for each patient i.e. Tissue or Mesh Repair or PHS, Kugal Mesh is of paramount importance.
    •  Technician (i.e. Surgeon)
      Surgeon performing the operation should be well experienced in the procedure, has the ability to select the best technique and has innovative ideas. A combination of all these qualities with full co-operation and compliance by the patient brings excellent results in Hernia surgery.

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    Success Rate

    Modern treatment of various types of Hernia in general and Groin Hernia in particular is so designed that the success rate has reached almost 99.7%. Recurrence is rare and local anesthesia complications are unknown in the hands of dedicated expert Hernia surgeon performing surgery under strict aseptic precautions.

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    Post Hernia Surgery Do's and Don'ts

    Do's :

    • Ambulatory Hernia surgery allows patients to walk as much as possible, which helps in faster recovery. One can climb the staircases as per one's ability.
    • Normal diet and plenty of liquids are advised, with mild laxatives at night to help smooth bowel movement.
    • Rest at home for 2-3 days is advised.
    • Patient can take bath everyday if advised.
    • To take medicines regularly as advised.
    • To visit his Surgeon periodically for first 3 months and thereafter when required.

    Don'ts :

    • Avoid strenuous work and lifting weight over 5kg, for 2 months.
    • Avoid diet which may cause cough and cold, and if present to take treatment for the same immediately.
    • Avoid bending forward too frequently.
    • Do not continue to suffer from constipation, but treat it at the earliest.
    • Do not gain weight for at least 6 months post-operatively.
    • Avoid talking too loudly.
    • Avoid Yoga and other exercises as per the advice of his Surgeon and perform only such exercises as permitted by the Surgeon.

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    Day care Ambulatory Hernia surgery

    Following advantages make Day care Ambulatory Hernia surgery very safe:

    • Patient starts walking soon after completion of the surgery and need not lie down in the bed, hence it is called as Ambulatory Hernia surgery.
    • Surgery is performed under local anesthesia. Patient is safely discharged on the day of the operation or on the next day. Hence economical.
    • No need to take injectable medicines after discharge from the hospital.
    • Pain is minimal and is taken care of by pain-killer medicines.
    • Absence of external stitches and application of water-proof dressing allows the patient to take bath as usual.
    • Patient can have normal diet after the operation.
    • Patient can drive car after 2-3 days.
    • Life style of the patient is not altered much.
    • Patients can resume office work in 2-3 days.

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    GROIN HERNIA

    Our Surgeon is Ambulatory Hernia Surgeon .

    Surgical gastoenterologist, has experience of 36 years in surgery and 25 years in modern hernia surgery under local anesthesia.

    Over last 25 years he has performed large number of hernia operations using various techniques depending on the type of hernia, patient's occupation, associated other disease and age group, with local anesthesia, With excellent results.

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    OTHER TYPES OF ABDOMINAL HERNIA (OTHER THAN GROIN HERNIA):

    Are very well repaired using local/spinal/general anaesthesia. Most of these repairs are performed by using appropriate mesh.

    Abdomino plasty + Abdominal hernia

    Larger type of abdominal hernia with lot of fat on the abdomen and lax abdominal muscles are suitable cases for this type of repair in which not only hernia repair is achieved but also reduction of the pot belly with tightening of the muscles is achieved.

     

    Navjeevan Hospital

    Near Ramji Ashar School ,
    M.G. Road , Ghatkopar (East)
    Mumbai 400 077.
    91-22-21026280/21028527
    FAX NO.:91-22-21026280
    FOR APPOINTMENT CELL NO: + 91 9819866660 (DR. NARENDRA MEHTA)
    + 91 9920189159 (SECRETARY)

    Accomodation

    • Special Room : AC, Color TV, Bathroom.
      extra bed for attendant of a patient.
    • Twin : Same facility but 2 patients in a room.
    • Non AC : Twin Bed
    • I C U Room 3 beds
    • Day care beds : 2 beds.
    • General beds : 4 beds.
    • Well equipped Operation Theatre.
    • Well trained & experienced Nursing Staff
    • Availability of food optional

    Hospital accepts all patients of abdominal diseases.

    In-House Modern Pathological laboratory available.

    Affiliation to other Hospital

    Lilavati Hospital (Multi Speciality Hospital)

    Tel : 91-22-26568050/51 (For Appointment) 8 am.-10 pm.
    Cell No.: 91-22-9819866660

    Mon & Wed :- 10-12 morning Fri :- 4 to 6 Evening.
    Operation Performed : Everyday.
    All Abdominal Operation undertaken in addition to Hernia Surgeries.
    All different types of room, common to super deluxe available.

     

     

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