Does your hernia wet your cornea ?
What is a hernia? Do you have it? If you do have it, how do you know? Is it painful? Is it hereditary? What exactly causes it? Does the belly bump cause hernia, the lump? Do you need surgery to correct it? So many questions! Let’s start with addressing the first one.
What are the different types of hernia?
Depending upon the site of the uneventful, there are different types of hernias. Umbilical hernia, femoral hernia, incisional hernia, epigastric hernia and hiatal hernia. In this article, inguinal hernia is being discussed.
A Hernia – It’s an abnormal protrusion of an organ or part of it through a weak point in the body. Inguinal hernia is the most common one among hernias, affecting mainly men than women in 7:1 ratio, respectively. You don’t want equality in these matters ladies, trust me! Hernia can be direct or indirect. In GOT (game of thrones), remember Hodor? The scene where the white walkers attack Bran and they’re running for their lives? Hodor holds the door, So that the white walkers don’t kill Bran and turn him into one of them. If Hodor played security at the entrance of the tower and the white walkers still got in? It would be an indirect hernia. Here, the white walkers can be the abdominal viscera mainly the colon and Hodor is the deep inguinal ring. Similarly and also how it happened in GOT, Hodor stood at the back door of the tower and white walkers crawled out eventually. Here, it’s a direct hernia and the iconic Hodor, being the posterior wall of the inguinal canal.
What is this inguinal canal?
It is a muscular canal containing structures running through it. They are the spermatic cord (in males), round ligament (in females), Ilioinguinal nerve, there is a genital branch of what’s called a genitofemoral nerve and lastly remnant of processes vaginalis. The weak area of all groin hernias is the site between the inguinal ligament and the iliopubic tract called the myopectineal orifice of Fruchaud.
What causes hernia?
Sometimes, people are born with it. There can be a collagen disorder due to which the ligaments become weak, prune-belly syndrome is congenital and acquired collagen deficiency is due to smoking. Yes, smoking not only causes cancer but also hernia. They forgot to put that on the pack. Basically, anything increasing the intra-abdominal pressure adds to the causation of the hernia like coughing, constipation, ascites, obesity, pregnancy, straining during micturition and lifting heavy weights. Hernia cases have been recorded post appendectomy as well. does your hernia takes too much time to recover the answer to this question is, it takes a couple of weeks to recover and the way you maintain your daily diet.
Younger you are indirect hernia is a possibility and older you get direct hernia occurs. Inguinal hernia usually presents itself as a groin swelling and is painful in nature and it might be radiating to the umbilical region.
Normal investigations done for diagnosis are,
- The routine blood tests and urine examination. The elderly might need an additional bunch few tests like a chest X-ray, ECG and PFTs. Urinary complaints are checked for prostatic enlargement and urethral problems.
- Ultrasound can detect a sac where hernia cannot be diagnosed by clinical assessment. It is useful in postoperative swellings, hematoma and recurrence.
- CT (computed tomography) for giant hernias.
- MRI (magnetic resonance imaging) is ideal for sportsperson, to differentiate between muscle spasm and a hernia.
Treatment for a hernia depends on its presentation. Herniotomy, herniorrhaphy and hernioplasty are the three important operative techniques which are performed. For adolescent patients with hernia, herniotomy is preferred.
Herniorrhaphy – Modified bassini’s herniorrhaphy is in practice now for patients who have a good muscle tone with indirect and direct hernia. In this procedure, the surgeon repairs the stretched out ligament and herniotomy is also conducted. Shouldice repair is another type of herniorrhaphy where herniotomy is done with correction of the hernia using the surrounding tissues by absorbable and non-absorbable sutures in different layers.
The third operative method is the hernioplasty, which is done in patients with or without good muscle tone having indirect or direct hernia and also in recurrent hernia. This approach is done so as to strengthen the posterior wall of the inguinal canal. Firming up is done by repairing the weak posterior wall by a prolene mesh or Marlex mesh. A thick fibrous layer is hence formed as it acts as a foreign body and our immune system provides the required cement to it. An artificial deep ring is also done. This mesh technique is quiet brilliant as it has a long life, preferably socioeconomic; risk of infection is minimal when handled in a sterile environment and also due to its amazing biocompatibility. Prolene darning is also done in a few cases, which is basically sewing up the loose ends and making it stronger.
There are few other techniques like the Kuntz operation usually done in elderly, Mcvay, Nyphus repair, Stoppa repair, Marcy repair. Newer advancements are game changing procedures like the Dasarda technique, creating a hernia system which is exceptional and mesh plug repairs are gaining popularity as they have much better patient compliance.
Laparoscopic surgery or open surgery? In my opinion, open is a better choice for this condition. But both have their own pros and cons. Open surgery does interfere with the bowl function. Also, if there are any complications during the laparoscopic surgery the surgeon would have to open up and go old school. Plus, open surgeries are cheaper as compared to laparoscopic but the recovery period varies indistinguishably.
Complications are often common after a surgery. They can be during, before or after the surgery. They aren’t worrisome but few need to be attended by the surgeon. Care must be taken to avoid post-operative wound infection by the patient or their care takers. In very few cases patients complain of lower abdominal pain a characteristic dragging pain months after surgery which might be due to injury to the surrounding nerves. This is treated by nerve blocks with anaesthetic agents and steroidal injections.
If hernia is not treated at the right moment it can give rise to a number of complications which are troublesome like,
- An obstructed hernia.
- A strangulated hernia is quiet notorious as it can cause shock and sepsis and need immediate surgical care as the bowel might get gangrenous.
- A Sliding hernia is an incarcerated hernia in which the fecal matter may slide into it.
- Inflammation is yet another impediment which might range out from a simple hernia to a life threatening one.
- Recurrent hernia is common is 10 percent of the lot who has been treated earlier.
With all due advancements in the surgical and medical field hernia is one of the most common cases till date which need effective, relentless and instantaneous treatment. So, don’t ignore a lump because it is not so Gump.
Written By (Dr) Apoorva Manjunath