What is a Hernia?

A hernia is a defect in the abdominal wall, in which the inside layers of the abdominal muscle have weakened resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small bubble or balloon-like sac. When a loop of intestine or abdominal tissue pushes into the sac, severe pain and other potentially serious complications can result.

Both men and women can get a hernia. Some hernias are present at birth (congenital), while others develop over time. A hernia does not get better over time; a hernia will not go away by itself. Hernias most commonly occur in the groin (‘inguinal hernias’), around the belly button (‘umbilical hernias’), and near the site of a previous surgical operation (‘incisional hernias’).

Types There are two kinds of Hiatal Hernia : –

• The first (95%) is the sliding hiatal hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.
• The second kind is rolling (or paraesophageal) hiatal hernia, when a part of the stomach herniates through the hiatus beside, and without movement of, the gastroesophageal junction.

What Causes Hernias?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness in the abdominal wall present at birth. Anyone can get a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate, and hernias to form.

Treatment Options in India

There is no acceptable nonsurgical medical treatment for a hernia. The use of a truss (hernia belt) can help keep the hernia from bulging but eventually will fail. The truss also causes the formation of scar tissue around the hernia making the repair more difficult. If you suspect you have a hernia, consult with your physician or surgeon promptly. Delayed hernia repair can result in intestinal incarceration (intestine is trapped inside the hernia sac) or strangulation (intestine is trapped and develops gangrene). The latter is a surgical emergency.

The hernia will not go away without treatment; it will only get bigger. The bigger the defect the bigger the operation required to fix it.

Under certain circumstances the hernia may be watched and followed closely by a physician. These situations are unique to those individuals who are at high operative risks (i.e. those with severe heart or lung disease, or bleeding problems). Of course, even in the high risk person, if the symptoms become severe or if strangulation occurs, then an operation must be performed.

Surgical Repair in India

There are two main options for hernia repair : –

1. Open Repair : – The traditional, open repair has been the gold standard for over 100 years. There are 5-10 different approaches that are performed routinely with local and intravenous sedation. Due to the larger size of the incision, open hernia repair is generally painful with a relatively long recovery period.

1. Minimally Invasive (Laparoscopic) Repair : – Minimally Invasive (Laparoscopic) Repair has been developed over the past decade. It is usually performed under general anesthesia but spinal anesthesia is also an option. Local anesthesia can be used under special circumstances.

Benefits of Minimally Invasive (Laparoscopic) Repair in India

• Shorter operative time
• Less pain
• Shorter recover period

Complications Surgery in India

A hiatus hernia per se does not cause any symptoms. The condition promotes reflux of gastric contents (via its direct and indirect actions on the anti-reflux mechanism) and thus is associated with gastro-esophageal reflux disease (GERD). In this way a hiatus hernia is associated with all the potential consequences of GERD- heartburn, esophagitis, Barretts oesophagus and oesophageal cancer. However the risk attributable to the hiatus hernia is difficult to quantify, and at most is low.

Besides discomfort from reflux and dysphagia, hiatal hernias can have severe consequences for patients if not treated. While sliding hernias are primarily associated with gastroesophageal acid reflux, rolling hernias can strangulate a portion of the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and even become ischemic and necrose. Another severe complication, although very rare, is a large herniation that can restrict the inflation of a lung, causing pain, breathing problems.

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