Frequently asked questions
Hernia is a protrusion of the internal structures or organs through a defect in the muscular walls. The most common site of occurrence of a hernia is in the abdomen. Hernia can also occur in areas like the thighs, groin and below the belly button. Hernias are rarely a life-threatening disease. But a hernia won’t resolve on its own. It needs to be treated if it causes problems. If a symptomatic wait and watch policy can be adopted, a treatment can be delayed till problems appear. The problems due to hernia occur due to the pressure effects of the internal organs of the surrounding structures. Males are much more likely to develop a hernia than females. Almost seventy-five percent of all hernias are abdominal hernias.
Hernia repair surgery or herniorrhaphy is the surgical procedure undertaken to treat hernias. In this process the disturbed/displaced tissues is put back to their proper place and the weak spot through which the hernia emerged is strengthened by putting a mesh on it.
The first line of treatment for a hernia without any symptoms or mild symptoms is wait and watch. No treatment is required until the situation worsens, and symptoms start to appear. Surgery is required once the hernia starts giving problems.
Hernia surgery is usually a safe procedure, but as with any kind of surgeries, there are always some risk associated.
The aim of surgery is to reduce the hernia by pushing it back to its original position. The weak spot through which the hernia occurred is strengthened by placing a mesh.
Hernia surgery is of two kinds:
Open Hernia Surgery and Laparoscopic Surgery. Both open and laparoscopic approaches are used for hernia repair surgery.
Open Surgery for Hernia Repair:
The procedure is called herniorrhaphy. This is usually done under spinal or local anaesthesia depending upon the site. A large incision is made in the abdominal wall to access the hernia. Once the hernia is accessed, it’s pushed back to its original position by enlarging the defect through which it came out. Once this is done, the defect is sutured. A synthetic mesh is placed over the defect and sutured to reinforce it. The abdominal incision is then sutured, and a dressing is placed over it. The patient is then shifted to the observation room. Once deemed okay, the patient is shifted to the hospital room where he/she will remain for the rest of the hospital stay.
The duration of the surgery is usually between 45 minutes to an hour. The period of hospital stay is about 4-6 days depending on the recovery.
Laparoscopic Surgery for Hernia Repair:
A laparoscopic surgery is less invasive compared to an open surgery. In a laparoscopic surgery, three or four small incisions ranging below 1 cm is made instead of a single large incision as required for surgery. In laparoscopic surgery, a laparoscope and other surgical instruments are inserted into the abdominal cavity. A laparoscope which contains a camera transmits images of the internal organs into a monitor. The surgeon then repairs the hernia using specialised instruments introduced through other incisions. Being a lesser invasive surgery, the recovery is faster. The duration of surgery is about an hour and the hospital stay will be for a day or two. Since most hernias require the placement of a synthetic wire mesh to strengthen the faulty area, open surgeries are preferred if there are chances of recurrence.
Hernia surgery when done in the laparoscopic way does not take too long to heal. It usually takes about 3-6 weeks for a full recovery. Within 1-2 weeks of the surgery patients can also get back to work, provided the work does not involve strenuous activity.
Care after Hernia Surgery:
Hernia surgery is a routine procedure, however, as with any surgeries, there are always some risks involved. Proper precautions need to be taken to ensure the success of the surgery. If not followed, complications may arise which could lead to repeated surgeries. Lifting of weights is a strict no and so is bending over. Strenuous physical activity is to be avoided but light exercises to ensure proper blood circulation should be undertaken. Climbing of stairs should be kept to the minimum. Fibrous food should be taken, and junk food should be completely avoided. Laxatives should be taken to soften the stools in case of constipation. Straining during stools should be avoided. Medicines should be taken to prevent episodes of cough. Any signs of infection in the surgical site should be immediately reported to the doctor. They can include pain, bleeding, oozing of fluids or discolouration. The incision should be taken care of in a proper manner. It should be kept clean and dry to prevent infections. Follow up visits should be undertaken at the times prescribed.
Complications after Hernia Surgery:
Patients will face some amount of pain and swelling at the incision site post-surgery. Pain medications will be provided which can help reduce the inflammation and pain. Patients can also apply ice packs on the incision. Some of the complications associated with hernia surgery are:
• Blood clots
• Recurrence of hernia
• Urinary tract infection
• Kidney complications
• Pain and swelling
When to notify your doctor:
Patients should call their doctors or the hospitals asap, if they experience any of these symptoms/issues:
• High and prolonged fever
• Increased pain at the incision site
• Increased swelling at the site of incision
• Nausea or vomiting
• Difficulty with urine and bowel movements
• Swollen testicles
• Sharp abdominal pain
Hernia surgery is done in all top hospitals in India.
The cost of adrenalectomy in India is about 5,000 USD. This may vary slightly according to the hospital and the surgical team.
The factors which can influence this pricing are:
· The duration of the stay in the hospital
· The type of room selected – shared or private or deluxe
· The hospital selected
· The city where the surgery will take place
Apart from these patients will also need to factor in additional costs such as travel fare, hotel stay for their travelling partner, food and medications etc.
Hernias occur due to defects in the muscular wall of fascia that holds the internal organs in place. In certain situations, the internal structures exert pressure on the muscles or fascia. When this pressure increases, the defects in the musculature gives way and a hernia occurs. There are several factors that increases the pressure on the musculature. In cases of abdominal hernia, the main risk factors are:
• Lifting of heavy objects without proper abdominal support
• Repeated bending or kneeling
• Constant coughing or sneezing
• Constipation and associated straining by passing stools
• Enlargement of prostate
• Repeated dialysis
• Diseases like cystic fibrosis
• Pregnancy and childbirth
Types of hernia
Hernias are usually classified according to their site of occurrence. The most common types of hernias are: Inguinal hernia- Almost eighty percent of all hernias are inguinal hernias. They occur when the intestine protrudes through a defect in the inguinal canal region or the abdomen. They are more commonly found in men.
Hiatal hernia- This occurs when a part of the stomach protrudes into the chest cavity. This type of hernia is commonly found in those aged above fifty. The most common cause of this is a defect in the diaphragm which is a wall that separates the chest cavity from the abdominal cavity. A major complication of a hiatal hernia is GERD (Gastroesophageal reflex disease). In this condition, the stomach contents are pushed back into the oesophagus leading to acid reflex.
Umbilical hernia- This type of hernia is usually found in children under 6 months of age. The intestines of the child bulge through an opening in the abdominal wall below the belly button. Umbilical hernias are usually self-corrective. As the abdominal muscles grow stronger, the herniating organs get pushed back into their respective places. In rare cases, the hernia may persist, requiring surgical treatment.
Incisional hernia- This type of hernia usually occurs after a major abdominal surgery. The sutured area or scar tissue will become a weak spot soon after surgery. If proper post-surgical precautions are not taken while lifting weights etc., the internal organs may push out through the scar area.
Spigelian hernia- A very rare type of hernia that occurs in the centre of the abdominal cavity.
Obturator hernia- Another rare type of hernia commonly found in females where the hernia protrudes into the pelvic cavity.
Epigastric hernia- This is a rare type of hernia found in children. Hernias are also classified as direct or indirect. Direct hernias occur due to congenital defects in the muscular walls. Indirect hernias are usually acquired and occur due to a combination of factors. Pressure effects on the abdomen and a weak spot in the abdomen can create an acquired hernia.
A strangulated hernia occurs when the muscles surrounding the herniated portion starts exerting extreme pressure on it. A loss of blood supply might occur leading to destruction of the herniated tissue mass. This condition is a medical emergency and requires immediate surgical correction.
Symptoms and signs of hernia
The common signs and symptoms of an abdominal hernia are pain and swelling in the affected area.
➢ Pain in the abdomen
➢ Fullness in the abdomen
➢ Episodes of nausea and vomiting
➢ Discomfort in the abdomen while bending and coughing