Hernia is a common problem seen in males and females often. (It is the price mankind has to pay to assume the erect posture.)
Hernia is defined as a weakness of the abdominal wall causing abnormal protrusions of its contents.
Hernia commonly presents as a swelling that reduces itself on lying down.
Common causes of Hernia
It could be present from birth as a congenital Hernia. The common site is in the groin (inguinal).
It could be due to progressive weakening of the muscles involved, as seen with ageing and reduction of physical activity.
Hernia could follow previous surgery, which is an Incisional Hernia.
Umbilical Hernia is a result of protrusion through the umbilicus. They are seen more commonly in obese individuals and women.
Prolonged standing may cause a dragging pain over the site of Hernia due to gravity pulling on the swelling.
Hernia can get complicated as time goes by and may result in vomiting, constipation and bowel obstruction.
This may progress to strangulation due to the blockage of the blood flow to the bowel.
These are emergency situations that will require life-saving surgery for the patient to survive.
Examination of the patient
Examination of the patient reveals a reducible swelling in the abdomen. This swelling usually disappears on lying down.
There is an expansile cough impulse. This is also associated with weakness of the abdominal muscles.
Common investigations done
To confirm the diagnosis,
- We need to do an Ultrasound of the abdomen. (This will also rule out an enlarged prostate.)
- If it is a small Hernia in an obese individual, then a CT scan will be essential.
- Blood tests are performed to assess the condition of the patient. Haemogram, renal function tests, liver and thyroid function tests, clotting parameters, and serology is all done.
- Cardiac evaluation with an ECG and echocardiogram is done.
- Chest x-ray is essential.
Principles of surgery
A tension-free repair is done using a mesh. This will cover the defect and act as a layer on which fibrin can be laid down to reinforce the defect and close it effectively. (This ensures a pain-free environment.)
Anaesthesia – General, spinal, epidural or local anaesthesia can be used as appropriately as possible.
Both open and laparoscopic repairs can be used effectively to repair the defect and thus reinforce the Hernia.
The common complications are bleeding, infection, recurrence and mesh rejection.
Postoperatively, the patient is allowed to return to all normal activity.
There is no limitation in walking or stair climbing.
During the period of the swelling or in the immediate postoperative period, one should not lift weights or put any kind of strain on the abdomen as it may exaggerate the tear or the stitches may get torn. Careful management and proper rest should be followed. The recurrence rate of Hernia in a person is undetermined.
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