Hernia Treatment

PATIENT INFORMATION FOR LAPAROSCOPIC REPAIR OF HERNIA [INGUINAL/FEMORAL/UMBILICAL/EPIGASTRIC/INCISIONAL]

WHAT IS A HERNIA?

  • A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac.
  • Both men and women can get a hernia.
  • You may be born with a hernia (congenital) or develop one over time.
  • A hernia does not get better over time, nor will it go away by itself.

<h1 align="center"><strong>PATIENT  INFORMATION FOR LAPAROSCOPIC REPAIR OF HERNIA [INGUINAL/FEMORAL/UMBILICAL/EPIGASTRIC/INCISIONAL]</strong></h1> <ul>   <li><strong><a href="#1">WHAT IS A HERNIA?</a></strong></li>   <li><strong><a href="#2">HOW DO I KNOW IF I HAVE A HERNIA?</a></strong></li>   <li><strong><a href="#3">WHAT CAUSES A HERNIA?</a></strong></li>   <li><strong><a href="#4">HOW IS HERNIA TREATED?</a></strong><a href="#4"> </a></li>   <li><strong><a href="#5">WHAT IS A MESH?</a></strong></li>   <li><strong><a href="#6">WHAT SHOULD I EXPECT AFTER  SURGERY?</a></strong></li>   <li><strong><a href="#7">IS IT RISKY FOR  PEOPLE WITH OTHER MEDICAL PROBLEMS LIKE DIABETES, HYPERTENSION & MORBID  OBESITY?</a></strong></li>   <li><strong><a href="#8">WHAT  ARE THE OTHER PROCEDURES THAT CAN BE DONE LAPAROSCOPICALLY?</a></strong></li> </ul> <p><strong><a name="1" id="1"></a>WHAT IS A HERNIA?</strong></p> <ul type="disc">   <li>A hernia occurs when the inside layers of the abdominal       muscle have weakened, resulting in a bulge or tear. In the same way that       an inner tube pushes through a damaged tire, the inner lining of the       abdomen pushes through the weakened area of the abdominal wall to form a       small balloon-like sac.<strong> </strong></li>   <li>Both men and women can get a hernia. </li>   <li>You may be born with a hernia       (congenital) or develop one over time. </li>   <li>A hernia does not get better over time,       nor will it go away by itself.</li> </ul> <p><strong><a name="2" id="2"></a>HOW DO I KNOW IF I HAVE A HERNIA?</strong></p> <ul>   <li>The common areas where hernias occur are in the groin (inguinal),  belly button (umbilical), and the site of a previous operation (incisional). </li> </ul> <ul type="disc">   <li>You may notice a bulge under the skin.       You may feel pain when you lift heavy objects, cough, strain during       urination or <strong><u>daefecation</u></strong>,       or during prolonged standing or sitting.</li>   <li>Severe, continuous pain, redness, and       tenderness are signs that the hernia may be entrapped or strangulated.       These symptoms are cause <strong><u>of</u></strong> concern and <strong><u>warrant </u></strong>immediate       contact <strong><u>with</u></strong> your       physician or surgeon. </li>   <li>Bulge may disappear on lying down.</li> </ul> <p><a name="3" id="3"></a><strong>WHAT CAUSES A HERNIA?</strong> <br />   The wall of the abdomen  has natural areas of potential weakness. Hernias can develop at these or other  areas due to heavy strain on the abdominal wall, ageing, injury, an old  incision or a weakness present from birth. Anyone can develop a hernia at any  age. Most hernias in children are congenital. In adults, a natural weakness or  strain from heavy lifting, persistent coughing, difficulty with bowel movements  or urination can cause the abdominal wall to weaken or separate.</p> <p><strong>TYPES OF  HERNIA</strong></p> <ul type="square">   <li><strong>Inguinal       hernia             -  </strong>as shown in Fig 1<strong>                 </strong></li> </ul> <ul type="square">   <li><strong>Femoral       Hernia            -  </strong>as shown in Fig 1<strong>                       </strong><br />   </li> </ul> <p><strong>Other Hernias <br />   1. <u>Incisional</u></strong><u>-</u>It arises in the abdominal wall where  a previous surgical incision was made  In  this area the abdominal muscles have weakened; this results in a bulge or a tear.  This can allow a loop of intestines or other abdominal contents to push into  the sac. Incisional hernias occur in people who have had previous abdominal  surgery, and are more likely to occur in people who are obese or pregnant .Incisional  hernias are caused by thinning or stretching of scar tissue that forms after  surgery. This weakened scar tissue then creates a weakness in the abdominal  wall.       <br />   2. <strong>U<u>mbilical</u></strong><u>-</u> An  umbilical hernia is a condition in which a defect or hole exists in the  abdominal wall at the level of the umbilicus  (belly button). It   commonly is  found in neonates (babies). <em>Shown in Fig 1</em><strong> </strong><br />   <strong>3. <u>Epigastric</u></strong>-An epigastric hernia is a <a href="http://en.wikipedia.org/wiki/Hernia" title="Hernia">hernia</a> in the epigastric region of a human. Typically  there is a small defect of the <a href="http://en.wikipedia.org/wiki/Linea_alba" title="Linea alba">linea alba</a> between  the <a href="http://en.wikipedia.org/wiki/Rectus_abdominis" title="Rectus abdominis">rectus abdominis</a> muscles. This allows tissue from inside the abdomen to herniate anteriorly. (Shown in Fig 1 )<strong> </strong><br /> </p> <p><strong><a name="4" id="4"></a>HOW IS HERNIA TREATED?</strong><strong> </strong></p> <ul type="disc">   <li>Hernias       usually need to be surgically repaired to prevent intestinal damage and       further complications.</li>   <li>Use       of a truss {hernia belt} is usually ineffective.</li>   <li>Surgical       procedures are done in one of the two fashions:-Your surgeon will       determine the best method of repair for individual situation:-</li>   <ul type="square">     <li> <strong><u>The open approach</u></strong> is done from        the outside through a three or four         inch long incision in the groin. The surgeon may choose to use a        small piece of surgical mesh to repair the defect.<strong></strong></li>   </ul> </ul> <p><strong><u>The laparoscopic hernia repair</u></strong>. In        this approach, a laparoscope (a tiny telescope) connected to a special        camera is inserted through a trocar, a small hollow tube, allowing the        surgeon to view the hernia and surrounding tissue on a video screen.        Other trocars are inserted which allow your surgeon to work        "inside."   Three or four quarter inch incisions are        usually necessary.  The hernia is        repaired from behind the abdominal wall.     A small piece of surgical mesh is        placed over the hernia defect and held in place with small surgical        staples.  This operation is usually        performed with general anesthesia or occasionally using regional or        spinal anesthesia  </p> <p><strong>ARE YOU A CANDIDATE FOR  LAPAROSCOPIC HERNIA REPAIR?</strong> <br />   Only after a thorough  examination can your surgeon determine whether laparoscopic hernia repair is  right for you. The procedure may not be best for some patients who have had  previous abdominal surgery or underlying severe medical conditions.<br /> </p> <p><strong><a name="5" id="5"></a>WHAT IS A MESH?</strong> </p> <ul type="disc">   <li><em><u>MESH</u></em> Surgical material, made from synthetic plastic (i.e: <a href="http://www.hernia.com/mesh_def.html" target="_blank">Polypropylene</a>) or gortex) or even       biodegradable substances, used to repair hernias. These sterile mesh       "SCREENS", or "PATCHES" are soft, pliable, flexible,       and 'wafer - thin' so as to conform to body movement and size. Yet they       are remarkably strong to immediately add strength and fully repair the       hernia while allowing rapid resumption of "Normal" activities,       including <a href="http://hernia.tripod.com/faqs.html#k" target="_blank">SPORTS</a>. Many varieties, shapes and sizes of <a href="http://members.tripod.com/~hernia/meshsyst.html" target="_blank">Mesh Systems</a> are available. Hernias differ       from patient to patient, and we firmly believe that any given single mesh       system or manufacturer is not appropriate for effective repair of all       hernias. We therefore evaluate the anatomic and physical properties of       each hernia at the time of surgery, then use our expertise to select the       appropriate mesh form and <a href="http://hernia.tripod.com/vocab2.html#TENS#TENS" target="_blank">TENSION FREE TECHNIQUE</a> to satisfactorily       repair your hernia defect appropriately. </li> </ul> <p><strong><a name="6" id="6"></a>WHAT SHOULD I EXPECT AFTER  SURGERY?</strong> </p> <ul type="disc">   <li>Following the operation, you will be       transferred to the recovery room where you will be monitored for 1-2 hours       until you are fully awake. </li>   <li>With any hernia operation, you can       expect some soreness mostly during the first 24 to 48 hours. </li>   <li>You are encouraged to be up and about       the day after surgery. </li>   <li>With laparoscopic hernia repair, you       will probably be able to get back to your normal activities within a few days.       These activities include showering, driving, climbing stairs, lifting,       working and engaging in sexual intercourse. </li>   <li>A follow-up appointment within a week       after your operation is scheduled. </li>   <li>Strenuous activity and exercise are       restricted for 2 to 4 weeks after surgery.</li> </ul> <p><strong><a name="7" id="7"></a>IS IT RISKY FOR  PEOPLE WITH OTHER MEDICAL PROBLEMS LIKE DIABETES, HYPERTENSION & MORBID  OBESITY?</strong></p> <ul type="disc">   <li>Not       at all. On the contrary, absence of major trauma to the body causes       minimal disturbance of normal physiology. Hence, there is no risk of aggravation       of other conditions.</li> </ul> <p><strong><a name="8" id="8"></a>WHAT  ARE THE OTHER PROCEDURES THAT CAN BE DONE LAPAROSCOPICALLY?</strong><br />   Almost every organ in the human body has  become accessible to the surgeon and MAS can be applied to most of the surgical  procedures. Some of the conditions for which Minimally Access Surgeries are  commonly performed are:-</p> <ul type="disc">   <li>Abdomen       - Gall bladder stones, Appendicitis, Gastro – intestinal ulcers, Colorectal       Surgeries, Splenectomy.<strong></strong></li>   <li>Hernias – Inguinal,       Umbilical, Epigastric, Femoral& Incisional.<strong></strong></li>   <li>Urinary       System- Urinary stones, Enlarged prostate, Kidney & Bladder tumors.<strong></strong></li>   <li>Bones & joints </li>   <li>Chest – VATS for empyema, decortication and       Sympathectomy. </li> </ul>

Fig1.

HOW DO I KNOW IF I HAVE A HERNIA?

  • The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).
  • You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or daefecation, or during prolonged standing or sitting.
  • Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause of concern and warrant immediate contact with your physician or surgeon.
  • Bulge may disappear on lying down.
Hernia

Fig. 2

WHAT CAUSES A HERNIA?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, ageing, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

TYPES OF HERNIA

  • Inguinal hernia             –  as shown in Fig 1                 
  • Femoral Hernia            –  as shown in Fig 1                      

Other Hernias

1. IncisionalIt arises in the abdominal wall where a previous surgical incision was made  In this area the abdominal muscles have weakened; this results in a bulge or a tear. This can allow a loop of intestines or other abdominal contents to push into the sac. Incisional hernias occur in people who have had previous abdominal surgery, and are more likely to occur in people who are obese or pregnant .Incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall.

2. Umbilical An umbilical hernia is a condition in which a defect or hole exists in the  abdominal wall at the level of the umbilicus (belly button). It   commonly is found in neonates (babies). Shown in Fig 1

3. Epigastric-An epigastric hernia is a hernia in the epigastric region of a human. Typically there is a small defect of the linea alba between the rectus abdominis muscles. This allows tissue from inside the abdomen to herniate anteriorly. (Shown in Fig 1 )

HOW IS HERNIA TREATED?

  • Hernias usually need to be surgically repaired to prevent intestinal damage and further complications.
  • Use of a truss {hernia belt} is usually ineffective.
  • Surgical procedures are done in one of the two fashions:-Your surgeon will determine the best method of repair for individual situation:-
    •  The open approach is done from the outside through a three or four  inch long incision in the groin. The surgeon may choose to use a small piece of surgical mesh to repair the defect.
Hernia

Fig. 3

The laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a trocar, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other trocars are inserted which allow your surgeon to work “inside.”   Three or four quarter inch incisions are usually necessary.  The hernia is repaired from behind the abdominal wall.     A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples.  This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia .

Hernia

Fig. 4

ARE YOU A CANDIDATE FOR LAPAROSCOPIC HERNIA REPAIR?

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or underlying severe medical conditions.

WHAT IS A MESH?

  • MESH Surgical material, made from synthetic plastic (i.e: Polypropylene) or gortex) or even biodegradable substances, used to repair hernias. These sterile mesh “SCREENS”, or “PATCHES” are soft, pliable, flexible, and ‘wafer – thin’ so as to conform to body movement and size. Yet they are remarkably strong to immediately add strength and fully repair the hernia while allowing rapid resumption of “Normal” activities, including SPORTS. Many varieties, shapes and sizes of Mesh Systems are available. Hernias differ from patient to patient, and we firmly believe that any given single mesh system or manufacturer is not appropriate for effective repair of all hernias. We therefore evaluate the anatomic and physical properties of each hernia at the time of surgery, then use our expertise to select the appropriate mesh form and TENSION FREE TECHNIQUE to satisfactorily repair your hernia defect appropriately.

Prolene

Prolene

Proceed

Proceed

Dual Mash

Dual Mesh

WHAT SHOULD I EXPECT AFTER SURGERY?

  • Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
  • With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.
  • You are encouraged to be up and about the day after surgery.
  • With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a few days. These activities include showering, driving, climbing stairs, lifting, working and engaging in sexual intercourse.
  • A follow-up appointment within a week after your operation is scheduled.
  • Strenuous activity and exercise are restricted for 2 to 4 weeks after surgery.

IS IT RISKY FOR PEOPLE WITH OTHER MEDICAL PROBLEMS LIKE DIABETES, HYPERTENSION & MORBID OBESITY?

  • Not at all. On the contrary, absence of major trauma to the body causes minimal disturbance of normal physiology. Hence, there is no risk of aggravation of other conditions.

WHAT ARE THE OTHER PROCEDURES THAT CAN BE DONE LAPAROSCOPICALLY?

Almost every organ in the human body has become accessible to the surgeon and MAS can be applied to most of the surgical procedures. Some of the conditions for which Minimally Access Surgeries are commonly performed are:-

  • Abdomen – Gall bladder stones, Appendicitis, Gastro – intestinal ulcers, Colorectal Surgeries, Splenectomy.
  • Hernias – Inguinal, Umbilical, Epigastric, Femoral& Incisional.
  • Urinary System- Urinary stones, Enlarged prostate, Kidney & Bladder tumors.
  • Bones & joints
  • Chest – VATS for empyema, decortication and Sympathectomy.

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