Neyyar Medicity

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    Neyyar Medicity
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      Neyyar Medicity

      Neyyar Centre for Hernia

      Surgeries and Procedures

      What is a hernia ?

      A hernia is a bulge over the abdominal wall caused by a weakness or tear of the muscles which allows organs such as the intestines, fatty tissue inside the abdomen and urinary bladder to protrude through the defect. Patients usually notice a swelling under the skin and may experience pain and discomfort occasionally. Symptoms may worsen after prolonged standing, walking or straining (e.g. lifting of heavy objects).

      Most hernias occur as a result of weakness or defect in the muscles of the abdomen since birth. As one ages, this defect is further weakened by strenuous physical activity, lifting of heavy objects or incisions of a previous surgery.

      The risk of developing a hernia increases with:

      Types Of Hernia

      Hernias are named according to their location on the abdominal wall or occasionally their specific cause.

      Groin Hernia

      There are two types of groin hernias - Inguinal and Femoral. Inguinal hernia is the most common type of hernia and has two varieties - Indirect and Direct. Indirect hernia occurs through the groin in an area on the muscle where the male testis pierces and descends down during foetal development. Femoral hernia is more common in women and is known to cause acute problems.

      Incisional Hernia

      This form of hernia develops at the site of previous surgical incisions. The muscles around the incision site becomes weak and may lead to hernia formation. At times, multiple areas of weakness may develop with multiple hernias along the entire length of the scar and these can develop weeks, months or years after the initial surgery. Every subsequent surgery further weakens the muscle and increases the risk of hernia formation.

      Spigelian Hernia

      This occurs through the spigelian fascia which is just beside the rectus muscles of the abdomen. The hernia lies in between two muscles of the abdominal wall and is hence difficult to diagnose clinically. The surgeon may need to perform an ultrasound or computed tomography (CT) scan.

      Rare Hernia

      This includes obturator hernia, lumbar hernia, sub-xiphoid hernia and para-stomal hernia.

      Midline Ventral Hernia

      This can be epigastric (in upper abdomen), para-umbilical (around the umbilicus), supra-pubic (in lower abdomen) and sub- xiphoid (just below the rib cage in the midline).

      Umbilical Hernia

      This is one of the most common hernias. Women are more commonly affected than men probably due to a previous pregnancy. This area is particularly weak because of the umbilical cord attachment during birth.

      FAQs

      Most patients notice a bulge over the abdomen. Some patients may experience pain over the swelling particularly while straining, and/or during physical activity. Most hernias are diagnosed by routine clinical examinations. In some cases, an ultrasound or a CT scan can be performed

      Most hernias need to be repaired surgically to treat symptoms and prevent complications (e.g. strangulation of intestine). Truss or abdominal binder are just temporary measures while awaiting surgery.

      The only treatment for hernia is surgery to repair the defect in the muscle. By not undergoing surgery, the hernia may increase in size and a portion of the intestine or fat inside the abdomen may pass through the defect and get trapped. This may lead to blockage or strangulation of the intestine. Patients may also get a sudden onset of abdominal pain, distention of abdomen, persistent vomiting and constipation.

      Most hernias are operated under General Anaesthesia (GA). Local Anaesthesia (LA) can also be an option for patients who are not suitable for GA.

      Most patients go home on the same day. Few patients stay overnight for pain or social/familial reasons. Patients with large or complex hernia may have to be warded for a few days, depending on the complexity of the surgery.

      Inguinal Hernia Surgery

      Open Hernia Repair

      Done from an 8-10cm incision in the groin, the hernia is reduced and the defect in the muscles is repaired with a surgical prosthesis (mesh). For bilateral hernia, incisions on both groins are needed. This can be performed under LA.

      Laparoscopic (Keyhole) Surgery

      A laparoscope (tiny camera) and small instruments are inserted through 3 small holes into the abdomen. The hernia is then identified, reduced, and repaired with a mesh.This is usually carried out under GA. 2 types of Laparoscopic Surgery:

      1. TAPP (Trans abdominal pre-peritoneal)
      2.TEP (Totally extra-peritoneal)

      Why Keyhole surgery?

      Ventral Hernia Surgery

      Open Mesh Repair

      The skin incision depends on the size of the hernia, and is almost two to three times the size of the hernia. The hernia is pushed back and the defect in the muscle is closed with sutures. This is then covered by a mesh which is fixed to the abdominal wall with multiple stiches. For large hernias, we may need to place plastic tubes (drain) through the abdominal wall for a few days.

      Laparoscopic (Keyhole) Surgery

      A 1012mm incision is made at the flank and two additional 5mm incisions above and below the first cut, usually on one side of the abdomen. A tiny camera allows the surgeon to see the surgery on a TV screen and thin long instruments are also inserted through these cuts. The hernia is reduced back inside the abdomen, and the defect is closed with stitches and covered by a mesh from inside. This mesh is fixed to the abdominal wall with a few stiches and absorbable screw-like device (tackers).

      Why Keyhole surgery?

      Novel Techniques

      Single Incision Laparoscopic (SILS) Hernia Repair

      This offers an even less invasive method of hernia repair. The surgery is performed through just one incision of about 1.5 - 2cm over the abdomen using special device and instruments. By using only one cut, it results in lesser pain and better cosmesis.

      Robotic Surgery

      In large, complex and difficult hernias, laparoscopy may not be possible and patients invariably undergo open repair. As a result, patients may end up with large incisions, increased pain and wound complications after surgery. The robot is an advanced technology used by the surgeon to perform complex manoeuvres not possible by laparoscopy. The robot also allows us to perform the surgery through similar small incisions.

      Endoscopic Component Separation (ECS)

      In hernias with large defects, it is difficult to achieve closure of the abdominal wall. In such cases, ECS is performed. We incise on the muscles in the lateral abdominal wall to release the attachments and bring them to the midline to cover the defect. The robot may be used to perform this procedure.

      Post- Operative Advice

      Call us if you experience:

      • Persistent fever above 39°C
      • Bleeding
      • Chills
      • Increased abdominal pain or swelling
      • Persistent nausea or vomiting
      • Persistent cough or shortness of breath
      • Drainage from any incision

      OUR EXPERT TEAM FOR HERNIA

      Dr Vijin V

      Senior Consultant Laparoscopic and Robotic Surgeon
      International Hernia Trainer

      MBBS, MS, FPCM(USA), FMAS, FICRS, CLP(CANADA)

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