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Hernia Surgery

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Laparoscopic Hernia Surgery in Vadodara:

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Doctors perform both open and laparoscopic hernia repair based on what is best for the patient.

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Laparoscopic Hernia Surgery Treatment

What is a Hernia?

A hernia occurs when an internal portion of the body, such as the intestine, pushes through a weakened section of the muscle or tissue wall. Hernias are a common disease that affects both men and women, and their kind and severity vary greatly. A hernia does not get better over time, nor will it go away.

Common types of hernias include:

Hernias of the abdominal wall

  • Inguinal Hernia: occurs in the groin area and is the most frequent type of hernia, especially in men.
  • Umbilical Hernia: appears around the belly button and is more common in infants but also occurs in adults.
  • Hiatal Hernia: happens when the stomach pushes through the diaphragm into the chest cavity.
  • Incisional Hernia: develops at the site of a previous surgery.
  • Sportsman's Hernia: a soft tissue injury in the groin area, often seen in athletes.

Symptoms and When to Seek Medical Attention

The symptoms of a hernia depend on its location and severity. Common signs include:

  • A visible bulge in the abdomen or groin
  • Discomfort or pain when lifting, coughing, or bending over
  • Heaviness or pressure in the abdomen
  • Burning or aching sensation at the bulge site

If the hernia becomes incarcerated (trapped) or strangulated (cutting off blood supply), it requires emergency surgery. In such cases, symptoms include:

  • Sudden severe pain
  • Redness or discoloration of the bulge
  • Nausea or vomiting
  • Constipation or inability to pass gas
Hernia Symptoms

Muscle weakness and strain typically cause hernias. Depending on the cause, a hernia can develop quickly or over a long period. Here are the primary causes:

  • Congenital Defects: Some people are born with weak abdominal muscles, making them more prone to developing hernias.
  • Aging: As people age, muscles naturally weaken, increasing the risk of hernia formation.
  • Chronic Coughing: Persistent coughing increases pressure in the abdomen, which can lead to hernias, especially in smokers or those with respiratory conditions.
  • Heavy Lifting: Repeatedly lifting heavy objects without proper technique can strain the abdominal wall.
  • Obesity: Excess body weight puts additional pressure on abdominal muscles, contributing to muscle strain.
  • Straining During Bowel Movements or Urination: Often associated with constipation or enlarged prostate, this straining raises intra-abdominal pressure.
  • Pregnancy: The pressure exerted by a growing fetus can weaken abdominal muscles, making hernias more likely.
  • Prior Surgical Incisions: Scar tissue from previous surgeries can create weak spots, leading to incisional hernias.
  • Intense Physical Activity: Athletes and individuals involved in heavy physical exertion may develop what's known as a sports hernia.
  • Poor Nutrition and Smoking: Both can impair tissue healing and contribute to muscle weakening.

Diagnosing a hernia typically involves a combination of physical examination, medical history, and imaging studies. Here's how healthcare providers confirm the presence of a hernia:

  • Medical History Review: The doctor will ask about symptoms such as pain, discomfort during movement, lifting, or straining, and any noticeable swelling or bulge.
  • Physical Examination: Most hernias, especially inguinal and umbilical, can be identified through a visual and manual inspection. The doctor checks for a bulge in the abdomen or groin, which may become more noticeable when the patient stands, coughs, or strains.
  • Imaging Tests:
    • Ultrasound: Often used for inguinal and umbilical hernias, especially in children or thin adults.
    • CT Scan (Computed Tomography): Offers a detailed view and helps diagnose complex or internal hernias, such as incisional or hiatal hernias.
    • MRI (Magnetic Resonance Imaging): Sometimes used to identify smaller or sportsman hernias not visible via ultrasound or CT scan.

Inguinal Hernia

Most inguinal hernias occur in men, and a small percentage of women develop inguinal hernias. The reason for the much higher prevalence in men relates to significant anatomical and embryologic differences. They are of 2 types, direct & indirect. When women develop inguinal hernias, it is almost always of the indirect variety.

The formation mechanism is different, but the end result is the same lining sliding alongside a uterine ligament that traverses the inguinal canal and anchors into the pubic bone. Another factor contributing to a higher male prevalence is significant differences in boney pelvis anatomy between sexes. The inguinal floor in males is generally broader and subjected to internal forces at higher pressures. This promotes gradual weakening of the floor and eventual eventration or bowing outward of the muscular floor. This type of hernia has been referred to as a direct inguinal hernia. This type of inguinal hernia is thought to develop due to “wear and tear”.

Inguinal hernias can be repaired in an open or laparoscopic fashion, both with and without mesh. Mesh-free repairs are primary repairs, and several techniques have been described over the last century. In the past 30 years, the mesh has become increasingly used. Most surgeons will use mesh at this time as it has been demonstrated to reduce the incidence of hernia recurrence. In the last 20 years, laparoscopic techniques have been increasingly used to repair groin hernias. Unfortunately, laparoscopic techniques almost always require mesh for good repair.

The open repair requires a 4-6-inch oblique incision in the groin. First, the hernia is identified and reduced (pushed back into place). Next, a mesh is typically placed on top of the inguinal floor, increasing its strength and durability and covering the potential openings through which tissue can slide. This is referred to as an “onlay” technique. The laparoscopic techniques allow complete visualization of the inguinal region, including the femoral space. Once the anatomy is delineated, and the hernia is reduced, a mesh is placed under the abdominal wall defects. This is referred to as an “underlay”.

When inguinal hernias are approached from within the abdominal cavity or just outside the abdominal cavity (preperitoneal), the entire inguinal floor can be visualized. The entire area of weakness can be reinforced or covered. The open technique only exposes a small area of the inguinal floor, and thus comprehensive coverage is difficult to obtain. Laparoscopic and inguinal hernia repair enables the repair of the left and right sides simultaneously through three small incisions. Minimally invasive repair has also been demonstrated to be beneficial in those patients who are undergoing surgery for recurrent inguinal hernias. The recovery is generally quicker and with less pain and swelling. As a result, patients generally return to work sooner, and most patients can return to total activity within 3 to 4 weeks.

When performed by highly trained and experienced surgeons the recurrence rate is identical between open and laparoscopic hernias and is 1-2%.

Following surgery, you

  • Can take a shower only after 48 hours post-surgery on doctor’s advice.
  • Can go home on the day of the procedure or the next day.
  • Should avoid driving while taking painkillers as they induce drowsiness.
  • You can resume daily activities slowly, while strenuous activities should be resumed only after consultation with your surgeon.
  • Use an ice pack on the wound to reduce pain, prevent swelling and lessen bloody discharge from the incision if present.
  • Recover in about 3 weeks.

Like most surgical procedures, hernia repair is associated with the following risks and complications:

  • Reaction to anaesthesia
  • Infection
  • Bleeding at the operation site
  • Nerve damage and numbness of the skin
  • Damage to surrounding tissue
  • Although the recurrence of hernias is seen in less than 5% of patients after surgery, you would need to follow preventive measures.

Ventral Hernia

A hernia occurs when there is a hole in the muscles of the abdominal wall, allowing a loop of intestine or abdominal tissue to push through the muscle layer. A ventral hernia is a hernia that occurs at any location along the midline (vertical center) of the abdomen wall.

There are three types of ventral hernia:

  • Epigastric (stomach area) hernia: Occurs anywhere from just below the breastbone to the navel (belly button). It is seen in both men and women.
  • Umbilical (belly button) hernia: Occurs in the area of the belly button.
  • Incisional hernia: Develops at the site of a previous surgery. Up to one-third of patients who have had an abdominal surgery will develop an incisional hernia at the site of their scar. This type of hernia can occur anytime from months to years after an abdominal surgery.

When inguinal hernias are approached from within the abdominal cavity or just outside the abdominal cavity (preperitoneal), the entire inguinal floor can be visualized. The entire area of weakness can be reinforced or covered. The open technique only exposes a small area of the inguinal floor, and thus comprehensive coverage is difficult to obtain. Laparoscopic and inguinal hernia repair enables the repair of the left and right sides simultaneously through three small incisions. Minimally invasive repair has also been demonstrated to be beneficial in those patients who are undergoing surgery for recurrent inguinal hernias. The recovery is generally quicker and with less pain and swelling. As a result, patients generally return to work sooner, and most patients can return to total activity within 3 to 4 weeks.

When performed by highly trained and experienced surgeons the recurrence rate is identical between open and laparoscopic hernias and is 1-2%.

Following surgery, you

  • Can take a shower only after 48 hours post-surgery on doctor’s advice.
  • Can go home on the day of the procedure or the next day.
  • Should avoid driving while taking painkillers as they induce drowsiness.
  • You can resume daily activities slowly, while strenuous activities should be resumed only after consultation with your surgeon.
  • Use an ice pack on the wound to reduce pain, prevent swelling and lessen bloody discharge from the incision if present.
  • Recover in about 3 weeks.

Like most surgical procedures, hernia repair is associated with the following risks and complications:

  • Reaction to anaesthesia
  • Infection
  • Bleeding at the operation site
  • Nerve damage and numbness of the skin
  • Damage to surrounding tissue
  • Although the recurrence of hernias is seen in less than 5% of patients after surgery, you would need to follow preventive measures.
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