Hernia Surgery

A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient.

Hernias develop at certain sites which have a natural tendency to be weak, the groin, umbilicus (belly button), and previous surgical incisions.

Signs and Symptoms

• Lump in the groin area when standing/straining & disappears when reclining
• Pain at the site of the lump, especially when lifting a heavy object
• Swelling of the scrotum
• Excruciating abdominal pain (if you have strangulation)
• Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)

Course of hernia

Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since a hernia can be repaired effectively and with minimal risk, most surgeons recommend that a hernia be repaired when diagnosed, unless there is a serious medical problem which makes it too risky.

Treatment

Hernia repair (Surgery)

The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often a prosthetic material, or another plastic material, is sutured in place to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair.

Newer hernia repair involves minimally invasive laparoscopic techniques. However, a hernia operation with open techniques is still a valid option reaching the highest standards of care. Laparoscopic techniques of hernia repair are especially attractive when patients are dealing with a recurrent hernia or a bilateral inguinal hernia.

Achalasia

Achalasia, also known as oesophageal achalasia, is a condition in which the oesophagus (a tube that carries food from the mouth to the stomach) is unable to move the food into the stomach. Lower oesophageal sphincter (LES) is a ring of muscle fibres that surrounds the lower-most end of the oesophagus where it joins the stomach. LES acts like a valve between the oesophagus and stomach, preventing food from moving backwards into the oesophagus. In people with achalasia, the LES fails to relax during swallowing, resulting in the backward movement of the food.

The main symptoms of achalasia include difficulty in swallowing (dysphagia), regurgitation of food, heartburn, weight loss, chest pain, and cough.

Your doctor may order the following tests to diagnose achalasia:

Barium swallow test: The test involves swallowing a barium preparation while X-rays are taken. The barium coats the walls of the oesophagus and stomach and makes the abnormalities visible more clearly.

Endoscopy: This test allows the doctor to examine the inside of the patient's oesophagus, stomach, and portions of the intestine, with an instrument called an endoscope, a thin flexible lighted tube.

Manometry: It is a test that measures changes in pressures exerted by the oesophageal sphincter.

Treatment options for achalasia include:

• Medications: Medications such as nitrates and calcium channel blockers are recommended to relax the lower oesophagus sphincter.
• Botox: Botulinum toxin injection can be administered to help relax the sphincter muscles
• Balloon dilation (pneumatic dilatation): A small balloon is positioned at the LES and inflated in order to widen the opening for food to enter the stomach.
• Myotomy: It is a surgical procedure in which the sphincter muscle is cut to allow the oesophagus to open.

Depending on your condition, your doctor will decide which treatment is right for you.