Hiatal Hernia

Hernia is an opening formed by the lining of the abdominal cavity. Abdominal wall hernia occurs when the contents of the intestine bulges out of the abdominal wall. Hernias are developed at birth (congenital) or may appear later (acquired).

Hernia may be present at birth and occurs when the lining around the abdominal organs fails to close before birth. Hernia may also result if the connective tissue degenerates in the abdominal wall due to which pressure builds up in the abdominal wall leading to a bulge in the abdomen. Some of the other factors that worsen hernia are chronic cough, obesity, constipation, pregnancy, poor nutrition, smoking and stretching or straining abdominal muscles while lifting heavy objects.

Hiatus Hernia

Normally, the stomach is completely below the diaphragm. In individuals with hiatus hernia, part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen, and protrudes into the chest cavity. Hiatal hernia is more common and affects people of all ages.

Hiatal hernias are of two types:

Sliding Hiatal Hernia :- The top portion of the stomach slides up and down through the diaphragm with increased pressure on the abdominal cavity
Fixed Hiatal Hernia :- The top portion of the stomach moves up into the chest cavity and does not slide down into normal position.

Obesity, chronic cough, chronic constipation, smoking, and hereditary factors increase the risk of developing hiatal hernias. Hiatal hernia may not cause any symptoms but patients may experience chest pain, heart burn, belching, and hiccups.

Your doctor can confirm the presence of hernia by performing a physical examination. A special X-ray (using a barium swallow) will be ordered that allows your doctor to view the esophagus or by performing endoscopy.

Treatment

Surgery is the only treatment and is usually performed for hiatal hernias that enlarge in size due to increased intra-abdominal pressure causing intestinal obstruction and restricted blood supply which may lead to death of bowel tissues.

A hiatal hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital. The operation may be performed as an 'open' or 'keyhole' (laparoscopic) surgery. Your surgeon will decide which procedure is suitable for the repair and performs with your consent.

Laparoscopic or Keyhole surgery : Laparoscopic surgery is performed in a hospital operating room under general anaesthesia. The television camera attached to the laparoscope displays the image of the abdominal cavity on a television screen. The surgeon makes several small incisions over the abdomen to insert the balloon dissector and trocars (keyholes). A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision. Once the trocars (key holes) are placed, the keyhole instruments are then inserted to repair the hernia. After completion of the repair, the CO2 gas is evacuated and the trocars are removed and the tiny incisions are closed and dressed with a sterile bandage.

As common with other surgeries, hernia surgery is also associated with certain complications such as local discomfort and stiffness, infection, damage to nerves and blood vessels, bruising, blood clots, wound irritation and urinary retention.

Inguinal Hernia

Inguinal hernia is a condition where a part of the intestine protrudes out of the abdomen through a tear in the abdominal wall. Inguinal hernias most commonly develop in the area between the abdomen and thighs, in the area of inguinal ring. Inguinal hernias affect people of all ages and are more common in men compared to women.

Inguinal hernias are of two types :

Indirect Inguinal Hernia :- Indirect inguinal hernia often affects premature infants and is caused because of non-closure of inguinal canal and is a congenital disorder.
Direct Inguinal Hernia :- Direct inguinal hernia is common in adult males and is caused because of degeneration of tissues in the abdominal muscles.

Inguinal hernias cause discomfort and sharp pain which may be worsened with increased activity and relieved on rest. Patients may also experience burning or gurgling sensation at the site of hernia.

Femoral Hernia

Femoral hernia appears as a bulge in the upper thigh, is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the "femoral canal"(a tube-shaped passage at the top of the front of the thigh). It most commonly develops in women due to the wider pelvic region and also in older people.

Femoral hernias may be congenital or develop later in life. Certain factors such as chronic constipation, obesity, and stressful urination because of enlarged prostate may increase the risk of hernias. Patients with femoral hernias may have a bulge in the upper thigh area and may have symptoms such as abdominal pain, nausea and vomiting, and discomfort on standing or lifting heavy objects.

Hiatus Hernia

Hiatal hernias are of two types:

Sliding Hiatal Hernia : The top portion of the stomach slides up and down through the diaphragm with increased pressure on the abdominal cavity.
Fixed Hiatal Hernia : The top portion of the stomach moves up into the chest cavity and does not slide down into normal position.

Incisional Hernia

It occurs through a scar of any previous surgical incision made in the abdomen and usually develops after many years of surgery. Incisional hernias are small and only the peritoneum or tissue layer lining the abdominal cavity protrudes out. Incisional hernias are more common in obese individuals and in pregnant women. Risk is more in those who had multiple surgeries earlier and those who perform activities that impart a lot of stress on the abdomen.

Patients may experience pain and discomfort and there is always a risk of recurrence.

Umbilical Hernia

Umbilical hernia is a small bulge around the umbilicus (belly button). An umbilical hernia in an infant is caused by the incomplete closure of the muscles around the umbilicus. Smaller umbilical hernias often require no treatment and get closed by the age of two.However, larger umbilical hernias may necessitate surgical treatment. Umbilical hernias may also develop later in life during pregnancy. Conditions such as mucopolysaccharide storage diseases, Beckwith Wieldemann syndrome, and Down syndrome may increase the risk of umbilical hernias.

The bulge in umbilical hernia will be soft and bulges may appear when the baby cries or sits up.

Recurrent Hernia

Recurrent hernias, as the name implies, recur at the same site of earlier hernia. Recurrence is more common in obese individuals and those who had multiple surgeries earlier. Recurrence is more common with incisional hernias because the risk factors such as obesity may persist and cause recurrence.

Surgery is the best approach for recurrent hernias. However, the difficulty or complications increase on subsequent repairs. Recurrent hernias can be repaired with open surgery or laparoscopic surgery and the chances of infections are minimal with the laparoscopic approach. Certain preventive measures such as treating chronic cough before treating hernias, avoiding smoking, avoiding strain on the abdomen during bowel movement, and avoiding lifting of heavy objects may help in preventing recurrence.

Mesh & Hernia Repairs

Surgery is the best approach for hernia treatment. Various surgical techniques are used to treat hernias and it is recommended that using ' tension-free' repair method is beneficial preferably with incisional hernias. Also, surgery is recommended for recurrent hernias. In treating larger hernias, surgeons use a synthetic material called 'mesh' to close the defect or hole. The mesh minimizes the tension at the surgical wound and prevents recurrence. Mesh used in surgery also provides support to the weakened abdominal walls. These meshes are available in various sizes and shapes so as to meet the requirements.

Surgeons place this mesh either below or above the defect in the abdominal wall and will be held in place with sutures. This mesh provides support for the growth of new tissue and this tissue incorporates the mesh into the surrounding area.