What is a hernia?

A hernia is a weakness or defect in the connective tissues of the abdominal wall that allows a protrusion of fatty tissue or internal organs through the defect appearing as a bulge beneath the skin. A hernia may gradually increase in size over time getting larger and larger while interfering with daily activities. In some cases, hernia surgery may be needed. There are several types of hernias based on the location.

What causes a hernia?

A hernia may occur on the background of a weakness in the tissues of the abdominal wall formed during development as a fetus or from prior injury. Predisposing factors include ageing, pregnancy, obesity and chronic straining. The hernia is often precipitated by periods of straining of the abdominal muscles as occurs during heavy lifting, pushing or pulling, coughing, sneezing, constipation, or difficult urination.

Types of hernia, Inguinal hernia treatment in Pune, Inguinal hernia treatment in Pune, Femoral hernia treatment in Pune,Incisional hernia treatment in Pune, Umbilical hernia treatment in Pune, Lateral hernia treatment in Pune, Epigastric hernia treatment in Pune, Inguinal Hernia, Umbilical hernia

What are the symptoms?

A hernia typically presents as a bulge beneath the skin in the area of the defect in the abdominal wall. There is often a dull ache associated with the hernia that may precede the appearance of a bulge. The hernia is often reducible meaning that the bulge can be pushed back inside the abdomen or may return inside the abdomen when lying down.

The contents of the hernia can sometimes become trapped outside the abdomen creating a condition called an incarcerated hernia. This may be associated with moderate to severe pain. If the intestine is trapped outside the abdomen in the hernia then this can cause a bowel obstruction resulting in nausea and vomiting in addition to pain.

Trapping of the hernia may progress to a condition known as a strangulated hernia if there is a blood flow to contents of the hernia. This can result in the death of the contained tissues such as the intestine. This is associated with severe pain and is an emergency.

Types of Hernias

Dr Shashank Shah and Team works with all types of hernias and has treated one of the most complex hernias in the globe. Learn more about the kinds of hernias you may be experiencing and the hernia repair procedures offered at LOC.

1. Inguinal (Groin) Hernia

An inguinal hernia typically occurs as a bulge in the groin. It is more frequent in men than in women. In men, depending on the type of inguinal hernia it may descend into the scrotum.

2. Femoral Hernia

A femoral hernia usually occurs at the upper aspect of the inner thigh in women.

3. Umbilical Hernia

An umbilical hernia occurs at the navel or belly button.

4. Incisional Hernia

An incisional hernia occurs at the site of a previous surgery. This type of hernia is usually caused by the injury to the tissues from the previous surgery.

5. Ventral Hernia

These are types of hernias that arise at the front of the abdominal wall. They include incisional, epgastric (located below the sternum or “breast bone”), and spigelian hernias (located off the midline towards the side of the abdomen).

6. Hiatal Hernias

A hiatal hernia occurs when a part of the stomach protrudes through a weakness in the diaphragm into the chest cavity. The weakness may be congenital, acquired after injury, or resulting from predisposing factors such as chronic straining, pregnancy or obesity.In some cases hiatal hernia surgery is necessary.

Hiatal hernias typically produce symptoms in older women.

7. Complex Hernia

This is a term often used to describe a type of hernia that is complicated to treat. This may include recurrent hernias, giant hernias, or hernias with associated fistulas or infections, among others.

How is a hernia diagnosed?

A hernia can be usually detected with a physical examination. We may also recommend a few tests to be done in order to further assess the patient’s condition and the root cause of the hernia. Mentioning them below

  • Ultrasound: This test uses sound waves to scan the patient’s body.
  • A barium X-ray: It takes images of the patients digestive organ and intestines.
  • A computed tomography: Also known as CT scan uses X-rays to get pictures of the particular organ.
  • An endoscopy: It studies the patient’s oesophagus and stomach with the help of a small camera at the end of a flexible tube.

What is the treatment of a hernia?

The treatment is based on the features of the hernia, its impact on your quality of life, and your general state of health. Treatment options may include observation, use of a supportive device, or surgery. Surgery is the only way to fix a hernia. In some cases emergency surgery is required. The treatment option that is right for you will be based on a discussion between you and your surgeon.

Indications for hernia repair surgery include:

  • Symptomatic Hernia: Hernia creating symptoms of discomfort, pain or interfering with activities of daily living.
  • Incarcerated Hernia: Hernia trapped outside the abdominal wall and cannot be returned back inside the abdominal cavity.
  • Bowel Obstruction: Hernia causing a blockage of the intestines requires surgical repair.
  • Strangulated Hernia: Hernia that has compromised the blood supply of the contents. There is a high risk of death of the tissues such as intestines that are contained in the strangulated hernia. This requires emergency surgery.

Laparoscopic Repair

The laparoscopic repair uses small incisions on the abdominal wall through which the instruments are placed into the abdominal cavity. The abdomen is filled with air and the repair is guided by the use of a camera. The hernia contents are brought back into the abdominal cavity and a mesh is secured in place to cover the hernia defect from the inside. The mesh helps to prevent its recurrence.

The laparoscopic repair has the advantages of quicker recovery, less pain, and less risk of infection.

Open Repair

The open repair is the traditional approach to hernia repair surgery with an incision made over the area of the hernia. The contents are returned back into the abdominal cavity and the sac is removed. Depending on factors such as the location and the size of the hernia, a mesh is often used to cover the area of the hernia defect. Otherwise, the defect is closed with sutures.

The open approach is commonly used for very large hernias or those that are complicated by factors such as bowel obstruction, infection, incarceration, strangulation, or recurrences.

Use of Mesh

A mesh is a supporting structure used to give strength to the hernia repair. It is used to cover the defect and reduce tension in the repair. Tension, otherwise, can lead to the recurrence of the hernia.

The mesh is made of synthetic material such as polypropylene or polyester. Alternatively, the mesh may be a biologic graft derived from animal tissue. The biologic grafts are often used if there is a great concern for infection as they tend to be resistant to infections.

Choice of Repair

The decisions regarding the laparoscopic vs. open approach hernia repair surgery and regarding use of mesh vs. no mesh will be individualized based on the characteristics of the hernia and the discussion you have with your surgeon.

Frequently asked questions (FAQ)

For treatment of hernia, surgery is the only option since it is a mechanical defect. Hernia doesn’t go away with medications. Pain can be one of the symptoms and if there is pain the patient needs to get treated. But other symptoms like indigestion, acidity, discomfort, pulling sensation and can affect daily activities, if this happens and hampers activities in any way then it is ideal most to get it treated. Generally pain occurs if there is obstruction or if the blood supply to the organ is cut off due to strangulation. In such cases an emergency may occur. Also, if the hernia becomes bigger and the muscles weaken even more due to a delay then the surgery can be complicated and recovery could be difficult.

There are various types of hernias:

Inguinal Hernia : These hernias generally develop in the lower abdominal wall. The intestines push in the weak spot of the inguinal canal found in the groin. This type of hernia is most common in men.

Umbilical Hernia : Umbilical Hernia occurs when the abdominal wall near the belly button weakens and intestine or fat tries to budge out. This hernia can be found in children and babies and this is the only hernia which may go away as the child grows and abdominal wall becomes stronger. If it doesn’t go away after the age of 5 years then it may require surgical treatment. In adults, this hernia could be due to repeated strain which can be caused by obesity, pregnancy or heavy weight lifting.

Hiatus Hernia : When a part of the stomach protrudes through the diaphragm into the chest cavity it gives rise to gastro-esophageal reflux and burning sensation in the chest. Sometimes they can have no symptoms and burning sensation in the chest and abdominal discomfort could be signs. If seen in children it could be a congenital defect.

Ventral Hernia : A weakness or bulge on the abdominal wall a bulge of tissues through an opening of weakness within your abdominal wall muscles is called a ventral hernia. It can be caused due to obesity, pregnancy or strenuous activities. When a previous surgical cut on the abdominal wall doesn’t heal well or there is surgical scarring it can cause the muscles, intestine or tissues to bulge and form a hernia this is generally called an incisional/ ventral hernia. There are many other uncommon types like femoral hernia in females, Spigelian hernia ,Internal hernias etc.

The most common sign of hernia is a bulge or a swelling in the abdominal wall or umbilical region(naval area) or the inguinal region(groin). Along with the bulge there could also be pain, discomfort, soreness which increases on coughing, straining or strenuous activity like weight lifting.Any abdominal symptoms like constipation, bloating may be related to the symptoms of hernia

A mesh is a prosthetic flat sheet that is used to repair the patch of the defect. Though all hernias may not always require a mesh but depending on the size of the hernia and defect whether a mesh is required or not can be a decision of the surgeon once he examines the patient. But large defects may require a mesh for successful repair of the defect. Compared to simple suturing, with mesh the chances of the hernia recurring are very low.

A hernia truss or belt is generally used to keep the contents of the hernia inside the abdominal wall. The truss creates a pressure over the defect there by minimizing the discomfort and symptoms. Though the truss or belt can be a temporary treatment but it cannot be a long term solution to the problem. One must remember that the truss can only be used if the hernia gets reduced completely and remains completely inside with the truss in place. Most doctors do not recommend use of the truss since it does not cure the hernia nor prevent any complications.

For hernia, surgery is almost always the only option since medications or any other treatment may not cure hernia. Surgery can be day care, minimally invasive. With the advance of laparoscopy, hernia can be treated endoscopically.

One of the complications is increase in size of the hernia over time.If a hernia remains untreated it can cause serious complications. If the hernia grows in size it can put pressure on the tissues around thereby causing pain and swelling. Another possible complication could occur if the hernia gets obstructed with the bowel as its contents can cause nausea, constipation or severe pain. Also, if the obstructed part does not get sufficient blood supply that part can get infected and gangrenous thereby making it a medical emergency.

Hernia surgeries with the advancement in technology and science can be done almost like day-care procedures. The patient can get admitted on the day of surgery and can go back home almost the same day. Recovery from the wound healing may take up to 7-10 days. A person walks to the operation theatre and walks back from the theatre and is active and moving about post surgery

Depending on the type of hernia, size and place the mesh can be reinforced using sutures, tacks or glue in order to hold it in place and prevent it from moving.
There are also types of mesh which can stick or can be retained without sutures, 3 D mesh is one such type. Over time it becomes like a part of the body and the patient's tissues grow into the mesh pores making it a part of the body and strengthening the wall of the damaged or weakened muscles.

The mesh generally used in hernia repairs is a synthetic plastic material (either Polypropylene or (PTFE)). It is known to be totally inert or non-reactive in the body. Infection rates are extremely low if a proper protocol of asepsis is followed.

Almost all types of hernias can be repaired by minimal invasive technique. The surgery is done by making small incisions and inserting the special laparoscopic instruments and mesh to secure it in place. It is always done using general anesthesia thereby making the procedure, recovery and healing quicker and almost bloodless. Higher surgical skills are necessary if there are previous surgeries.

Those with higher risk for anaesthesia can be treated under local anaesthesia.The type of anesthesia that is administered generally depends on the size of the hernia. Generally if it is smaller, uncomplicated hernia it can be performed under local anesthesia. Under local anesthesia the patient is generally given a short acting sedative and then local anesthesia is administered at the site of surgery. The surgery is performed only after the area is completely anesthetized and the patient is comfortable and pain free.
The major benefit of local anesthesia is that the surgeon could ask the patient to cough or strain to check the surgical repair.

Large and complex hernias can also be performed and in fact need to be performed in order to prevent the defect from increasing in size and to prevent serious complications like obstruction, strangulation, pain, severe constipation and vomiting. All hernias whether large and complex can be treated both laparoscopically and open. They may be treated under regional or general anaesthesia.

Hernia can be diagnosed by physical examination and by the help of Ultrasounds or scans. Large hernias can be easily seen by a physician or a surgeon but it is advisable to get an Ultrasound or scan in order to see the size of the defect and its contents to decide the type of treatment.

Almost all hernias are covered by insurance companies and can be done under both cashless and reimbursement methods. Ideally one must contact their insurance provider to get detailed information

Generally the surgery can be done as a day-care procedure and the patient can go home 24-48 hours after the procedure. After which the patient is generally called in for a follow-up 7-10 days after the surgery to see the wound healing and to remove the dressing and sutures if any.

Since there is minimal pain after the surgery, if a patient's job doesn't require physical exertion or straining of the muscles and more of a sedentary work life, such patients can get back to work in about a day or two after surgery. If the patient's job requires a lot of physical exertion, moderate activities can be resumed after a week and complete exertion is advised after about 3-4 weeks.

Activities like walking, light swimming and treadmill can be resumed immediately after the surgery. In Fact most patients are advised to remain active rather than being sedentary. In about 2 to 6 weeks the intensity of activities and sports can be increased. Though these are general guidelines the activities and sports one engages in differs from patient to patient and is best discussed with the surgeon and primary healthcare team based on the age, type of hernia surgery and the activities one performs.

There is no restriction on travel post surgery. The patient can travel back to his/her hometown a day after surgery. They can come back for a followup a week after surgery where they can travel without restrictions.

Tension free hernia surgery is generally performed using a mesh to cover the hernial defect.If there is no tension on the muscles by simple suturing, it is called tension free repair. Tension free repair of hernia is recommended in all hernia since it reduces pain and reduces recurrence.

After the consultation with the surgeon, the surgery can be planned in no time and recovery period is also not more than 24 hours. The surgery can be done as a day-care procedure and patients can go home the very day. Scheduling a hernia surgery is a fast process.

There are different types of meshes used.Laparoscopic repair are performed using a composite mesh which prevents sticking of mesh to internal organs. 3 D mesh repairs can be performed for umbilical or inguinal hernia. Flat mesh repairs are performed in open as well as laparoscopic surgery.

There are various reasons for developing hiatus hernia, some of the causes being:

  • Congenital: A person by birth could be born with a larger hiatal opening as compared to others.
  • Age: with age the diaphragm muscles may change or weaken thereby enlarging the hiatal opening.
  • Increase in Central Adiposity: In obese or overweight persons, during pregnancy, chronic cough, heavy and strenuous activities.
  • Injury to the area
  • weakness of the muscles or tissues

Some of the common symptoms of hiatal hernia that could be recognised by the patient themselves are:

  • Acidity with Gastroesophageal reflux and heartburn
  • Discomfort in the chest
  • Constipation
  • Bloating
  • Burping
  • Bad taste in mouth
  • Backflow of food or liquid into the mouth from the stomach which could occur even on lying down.
  • Vomiting
  • Discomfort or difficulty breathing due to shortness of breath

As is it known that hernia cannot be treated or healed by itself it will require surgical treatment at some point of time. In rare cases the hernia may not increase in size but it will continue to be the same size. It is advisable to treat the hernia when the size is small as the healing and recovery can be much faster. As the hernia gets bigger there are chances of obstruction and strangulation thereby cutting off the blood supply to that organ or tissue which could lead to gangrene of that part. When such a complicated hernia has to be treated it can be risky and recovery and healing may be delayed. Most people assume that since there are no symptoms or complaints it can be left untreated, but an untreated hernia may keep increasing in size hence ignoring a hernia can be dangerous and can have life threatening consequences.

Yes Hernia surgeries can be done without stitches. In such cases special surgical glue is used to seal and close the wound. This surgery will let the patient have a bath the next day of surgery and there is no need to remove the stitches or sutures and bandages can be removed in 7-8 days

Recurrence of hernia may vary depending on the type of hernia but the chances of recurrence are very low especially if it is a mesh repair. In case of a non-mesh repair the chances of recurrence are higher. Some of the reasons that could have led to the development of hernia could continue to be reasons for recurrence if precautions are not taken. For example., if a patient who has a huge central obesity with hernia does not lose weight and the central obesity keeps increasing in such situations hernia can recur as the mesh may get stretched and it may tear due to the abdominal pressure. Hence precautions need to be taken to prevent recurrence of hernia.