Hernia

A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. Hernias can develop around the navel, in the groin, or any place where you may have had a surgical incision. Some hernias are present at birth. Others develop slowly over a period of months or years. Hernias also can come on quite suddenly.
A hernia can be both seen and felt. You may notice it as a lump in your abdomen or groin that may or may not disappear when you lie down. You also may be aware of a dull aching sensation that becomes more pronounced when you are active. Most of the hernias do not hurt, or produce any sensations.
The discomfort you feel especially when you cough, lift something heavy, or stand for a long time comes from the constant pressure of tissue pushing its way through the weakened spot in your body. As more tissue pushes through the weakend area, the feeling of pressure increases. A hernia that develops or worsens quickly can produce a sudden intense pain as it enlarges. it may be symptom of strangulated hernia.
Hernias in the groin area (inguinal hernias) are most common in men, primarily because of the unsupported space left in the groin after the testicles descend into the scrotum. Hernia around the navel can be because of obesity / pregnancy / childbirth. They are more common in Women. Hernias in the femoral area, at the top of the thigh, occur most often in women. They commonly result from pregnancy and childbirth.
An untreated hernia will not get better on its own or with yoga although it may not get worse for months or even years. A hernia that can be easily pushed back or flattened (reducible hernia) is generally in less (10%) immediate danger to your health,although it can be painful. A non-reducible hernia, however, can become life-threatening if part of the intestine gets trapped, or strangulated, in the opening. This is also called an incarcerated hernia and in an emergency situation may require immediate surgery. Hernias (Incisional) are common in women undergoing Ceacerian & Gynaec Surgeries, or laproscopic surgeries.
Limiting activity or eliminating excess weight may provide temporary relief. Wearing a truss or binder has also offered temporary relief. The only cure, however, is surgery. There are two reasons for hernia surgery : to correct or prevent a dangerous strangulated hernia, and to eliminate the pain that may be interfering with your normal activity. Although there are always risks and side effects associated with any surgery, today's surgical techniques provide patients with treatment option that offer minimal postoperative discomfort, speedy recovery, and lasting relief with hardly any risk due to local anaesthesia.
Abdominal wall Hernia is one of the most common afflictions of man & it's repair with low recurrence is very important.
75% OF ALL HERNIAS ARE Inguinal Hernias. They are very much more common in Males than in Females. Hernias can be Direct due to muscle Weakness in elderly or Indirect (1% Males are born with Indirect hernias).
Recurrent hernia is the most common complication following repair of groin hernias. Reported recurrence rates vary from 0.1% to 20%, India's average recurrance rate is 20%.
Technical failure causes most hernial recurrences. A hernia repair under tension does not heal normally but is subject to disruption during the post operation period. Testing of repair by making patient cough during operation can avoid 99.99% recurrence, possible only when Hernia is repaired under local Anesthesia. Local Anesthesia Hernia Surgery is very safe even in patients with cardiac, chest, Neurological & Renal diseases.
"A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease." - Sir Cecil.
The hernia repair performed at this center enables us to be confident against recurrence 'for life'. Unfortunately, however, repairs performed elsewhere are not this reliable and failures can and, all too often, do occur at any time in the patient's life time.
When a hernia repair operation breaks down (i.e. a 'recurrent' hernia) further repair operations are more difficult than the first and, to make matters worse, the chances of success actually diminish with each successive attempt at repair.
Perhaps this is why Sir Cecil made above historical statement of the subject recurrences.
The entire operation can take 25 minutes or more.
The Technical simplicity means general anesthesia is not required, in almost all cases.
The peritoneal cavity is not entered mostly and there is no postoperative ileus or nausea.
Patients have less Pain-Decreasing the amount of dissection, lessens blood loss and results in significantly diminished patient discomfort.
Virtually elimates recurrence. In over 18,500 cases at Vrindavan Hernia Institute, we have 0.1% recurrence rate, in contrast, current standard operative techniques for primary or recurrent repair continue to result in 15%-20% failure rates.
With only local anesthesia required, patients are able to leave the hospital shortly after surgery. Patients are encouraged to resume normal activities, including weight lifting, the next day. Physician experts believe, that there are millions of individuals in the world with hernias that go untreated, many because of a general fear of hernia surgery. Improved patient satisfaction inspires more potential candidates to consider having this operation.
Umbilical Hernias, and adjacent hernias called "Paraumbilical hernias" develop in and around the area of the Umblicus (belly button or navel). A Congenital (present since birth) weakness in the navel area exists. This was the area, the vessels of the fetal and infant Umbilical cord exited through the muscle of the abdominal wall. After birth, although the Umbilical cord disappears (leaving just the dimpled belly button scar), the weakness underneath may persist. Hernias can occur in this area of weakness from birth, through late adulthood. The signs and symptoms some times include pain at or near the navel area as well as the development of an associated bulge or navel deformity. This bulge pushes the skin around the navel out, distorting the normal architecture in or around the navel (an `OUTIE'instead of a normal `INNIE'). Although often appearing at or just after birth, hernias can also occur at any time during later life. In INFANTS, these small hernias may gradually close by age of 3 and surgery can often be delayed until then, unless the hernias are causing problems or enlarging. In ADULTS however, umbilical hernias gradually increase in size and often become problematic. Incarceration or Strangulation may occur. Pain is absent in most inguinal and umblical hernias.
Optimally, these hernias should be repaired using a `Tension free' repair technique. These hernias occur in adulthood because of progressive and significant tension on the congenital area of weakness beneath the navel. This develops through the normal stresses and strains of daily activity. Any increase in intraabdominal pressure or weakness of abdominal muscles (during or after pregnancy or due to obesity) may cause paraumbilical Hernia in adults. Standard techniques, still widely utilized today, attempt to repair these hernias by simply closing the muscle defect under significant tension with sutures. Often, muscle layers are overlapped, creating even more tension. This only leads to unnecessary pulling of the tissues at the hernia area. We know that this tension on muscles inhibits normal healing, causes swelling, pain and prolonged recuperation. Excessively prolonged recovery, and more importantly, a high risk of recurrence. This need not be the case any longer. At the VRINDAVAN HERNIA INSTITUTE we repair these hernias effectively without tension. This contemporary surgical technique is performed most frequently with mild sedation and local anesthesia, thus avoiding the risk of General Anesthesia. The desired cosmetic concave or `hollow' appearance of the umbilicus or navel returns to normal after surgery and the navel is not removed. Patients are discharged after a day. Most patients start household activities like cooking etc. in a day or two, travel by local train to work in week's time, they can drive in a day or two.
A famous medical consultant's secretary did not know her Boss was operated because he finished his work on Saturday, got operated for Paraumbilical hernia, went home the same day. On Monday he went to both his consulting rooms, self driving car and worked normally.
At Vrindavan Hernia Institute more than 2500 such hernias are operated in the above fashion, successfully.
Epigastric, Spigelian, Femoral hernias are similarly managed using tension free technique under local anaesthesia.
INCISIONAL HERNIAS
As most of the patients are obese and need extensive tissue dissection, 1 to 4 days stay is essential-done under Spinal or general Anaesthesia 1% Recurrence rate & 0.1% chance of mesh rejection.
Incisional Hernias, say after Laparoscopy or T.L. may be operated under Local with sedation or G.A. using Plug, & Patient can go home in a day.


INSTRUCTIONS TO HERNIA PATIENTS
  • Tobacco consumption : (Smoking & Chewing etc.) is harmful.
  • Chronic constipation is to be avoided. If necessary by increasing consumption of fruits, vegetables, salads & water.
  • You should be fit to get up and about as soon as you get home.
  • You should go out for a walk every day after your operation.
  • Your hernia has been carefully checked. You can walk and exercise from the day of surgery (restricted only by pain in the first few days of surgery). You will be fit to resume office work in Two days time, depending on means of transport.
  • Swimming can be resumed in two week after operation. Car driving can be started in a day or two.
  • Sexual activity is best resumed genlty from two to four days after operation.



 

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