Hernia- When, Why and How!

What is a hernia?

A hernia is a swelling noticed over a normal or an abnormal hole in the abdominal wall. It results when the innermost layer of the abdominal wall protrudes through this hole. This allows the contents of the abdomen like intestine, urinary bladder to enter the hernia leading to complications.

What is inguinal hernia?

This is the commonest type of hernia resulting from a normal hole in the muscles of inguinal region. Most common contents include omentum and intestines. In some cases, these swellings slowly grow over a period of time and extend to the scrotum.

What is an incisional hernia?

This type of hernia develops through a hole over a previous abdominal surgery. Most common areas include the umbilicus or below the umbilicus after lower abdominal surgeries. 

What are the complications of an untreated hernia?

The intestine can get stuck in the hernia defect and lead to a block. Also, the blood supply to the intestines can be cut off leading to gangrene. These require emergency surgery. Hernia always requires surgery and cannot be managed with medicines. 

What are the methods of hernia repair?

The hernia can be repaired by either Conventional open surgery or Laparoscopic methods (Key Hole Surgery). Conventional mesh repair is one of the most common operations that general surgeons perform. Laparoscopic mesh repair involves approaching the defect from inside the tummy and this is being increasingly done worldwide due to many advantages.  

What is the principle of laparoscopic repair of hernia?

We can imagine a sandwich. Since the innermost layer protrudes through the defect, it makes logical sense to strengthen this layer. A polypropylene mesh is placed above the innermost layer. Thus, the intra-abdominal pressure pushes against the mesh and keeps it fixed there. Conventional surgery places it from outside and laparoscopic surgery places it from inside.

What are the advantages of laparoscopic hernia repair?

Laparoscopic approach has several advantages:

1.         Tension free repair
2.         Mesh put from inside reinforces the entire inner abdominal wall to prevent all others types of hernias also.
2.         Less tissue dissection and disruption of tissue planes
3.         Less pain postoperatively
4.         Low intra-operative and postoperative complications
5.         Early return to work

What are the chances of the hernia coming back?

Almost nil if the operation has been done properly by a trained laparoscopic surgeon as has been shown in numerous studies abroad.

Who can undergo laparoscopic surgery?

Laparoscopic surgery is done under General Anesthesia so fitness for anesthesia is a must. Any person who can be administered general anasthesia can undergo laparoscopic surgery. Pneumoperitoneum increases the risk in those with pre-existing disease conditions like cardiac diseases, COPD and elderly.

How safe is it to leave a mesh inside the body?

Its safety and efficacy has been proven without doubt by numerous trials all over the world.

Is laparoscopic surgery more expensive?

RETURN TO LIFE, QUICKLY – is the tagline of laparoscopic surgery. The equipment and occasional composite mesh increase the cost of surgery, as they are imported. However, the increased cost is offset by the gain associated by a lesser hospital stay, lesser requirement of medications, quicker and more productive return to work by the majority of the patients. The hidden lowering of cost is due to less leave, early return to normal activity and work, and also from the greatly reduced disruption of the family routine.

Dr. Vijaykumar Malladi
M.S. (General Surgery)
Fellowship Trained Laparoscopic Surgeon
MITR Healthcare hospital,
74-77, Chaturbhuj, Above IDBI Bank,
Near Shilp Chowk, Sector – 21, Kharghar – 420120.
Tel – 27743558, 9324180553
M – 9820709712, email: drvmalladi@gmail.com
www.mitrhealthcare.com

Published in Fourth Estate – 23rd to 29th May 2010