What Is A Hernia?

A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement.

Why Surgery Needed?

Serious complications from a hernia can result from the trapping of tissues in the hernia — a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

Where Are Hernias Located?

  • Indirect, Direct and femoral hernias which are defined by the location of the opening of the hernia from the abdomen to the groin.
  • Ventral hernia occurs in midline of abdomen usually above the navel(painless).
  • Umbilical hernia occurs within the navel.

Symptoms And Signs:

  • Pain or discomfort
  • Localized swelling on surface of abdomen or in groin.

How Is Hernia Repaired?

A hernia repair requires surgery. The principle of laparoscopic hernia repair Imagine a bathtub. When you put the rubber stopper at the outlet and fill it with water, the water pressure pushes the stopper in place and keeps it fixed there. The more the water, the firmer is the stopper. Now, if we were to put the stopper from the outside. Then the water pressure in the tub is going to push the stopper out as the pressure increases. This is Pascal’s law.

The same scenario can be imagined with placing a mesh on the hole where hernia treatment without surgery is. Is it going to be better fixed from outside or inside? Open surgery places it from outside and laparoscopic surgery places it from inside as is shown in the photographs below.

  • Fat being pulled in from the hernial defect, 2. The defect as it looks from the inside,
  • A mesh introduced like a rolled cigarette is being unrolled and
  • The mesh being fixed into place.

Different Types Of Hernia Are There and So There Are Varied Type Of Surgery.

Commonest Hernia is inguinal hernia; three broad category of surgery are

  • Herniotomy- Neck of sac is ligated done in young children
  • Hernioplasty- Neck of sac is ligated and posterior wall is repaired in young adults.
  • Herniorraphy-Neck of sac is ligated and posterior wall is reinforced with a foreign material called mesh.

There are two approaches for surgery for inguinal hernia and that is

  • Approach from front-by open technique. Most commonest and time tested approach.
  • Approach frm behind – by laparoscopy technique again either by intraperitoneal-TAPP
Preperitoneal- TEP
Preferred in both sides hernia & pairless procedure.