Monday, August 31, 2015

Symptoms, Causes, Prevention and Treatment of Hernia with Laparoscopic Surgery in Pune by Sanjay Kolte

What Is a Hernia?
A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 80% of all hernias are inguinal, and most occur in men because of a natural weakness in this area.
In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.
A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.
In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.


Hernia Causes
Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal wall weakness.
Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include:
·         obesity,
·         heavy lifting,
·         coughing,
·         straining during a bowel movement or urination,
·         chronic lung disease, and
·         fluid in the abdominal cavity.
A family history of hernias can make you more likely to develop a hernia. 


Hernia Symptoms and Signs
The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).


Reducible hernia
·         It may appear as a new lump in the groin or other abdominal area.
·         It may ache but is not tender when touched.
·         Sometimes pain precedes the discovery of the lump.
·         The lump increases in size when standing or when abdominal pressure is increased (such as coughing).
·         It may be reduced (pushed back into the abdomen) unless very large. 


Irreducible hernia

·         It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
·         Some may be chronic (occur over a long term) without pain.
·         An irreducible hernia is also known as an incarcerated hernia.
·         It can lead to strangulation (blood supply being cut off to tissue in the hernia).
·         Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.
Strangulated hernia
·         This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
·         Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
·         The affected person may appear ill with or without fever.
·         This condition is a surgical emergency.

Hernia Medical Treatment

Treatment of a hernia depends on whether it is reducible or irreducible and possibly strangulated.
Reducible hernia
In general, all hernias should be repaired to avoid the possibility of future intestinal strangulation.
If you have preexisting medical conditions that would make surgery unsafe, your doctor may not repair your hernia but will watch it closely.
Some hernias have or develop very large openings in the abdominal wall, and closing the opening is complicated because of their large size.
The treatment of every hernia is individualized, and a discussion of the risks and benefits of surgical versus nonsurgical management needs to take place between the doctor and patient.
Irreducible hernia
All acutely irreducible hernias need emergency treatment because of the risk of strangulation.
An attempt to reduce (push back) the hernia will generally be made, often after giving medicine for pain and muscle relaxation.
In cases in which the hernia has been strangulated for an extended time, surgery is performed to check whether the intestinal tissue has died and to repair the hernia.
In cases in which the length of time that the hernia was irreducible was short and gangrenous bowel is not suspected, you may be discharged from the hospital.

If a hernia that appears irreducible is finally reduced, it is important to consider a surgical correction. These hernias have a significantly higher risk of getting incarcerated again.