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 :
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(b).
Flat PTFE Mesh |
(c).
Flat VYPRO Mesh |
- PHS Mesh : Two layered , three dimensional
mesh.
- 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.
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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 35 years in surgery and 20 years in modern
hernia surgery under local anesthesia.
Over last 20 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.
Tel No. 91-22-2513 8337 / 25129280
Fax : 91- 22-25129280
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)
A-791 Bandra Reclamation
Bandra (West)
Mumbai – 400050.
Tel : 91-22-26421111 (For APPTT) 8 am.-10 pm. or
Cell No.: 91-22-9821137522
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.
Dr. Hiranandani
Hospital
Powai
Mumbai
Common to deluxe room available.
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