Chairman

Institute of Minimal Access, Metabolic & Bariatric Surgery (iMAS) Sir Ganga Ram Hospital | New Delhi

Medical Director

Bhatia Global Hospital & Endosurgery InstitutePaschim Vihar | New Delhi
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News & Highlights

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Media & Press Coverage

Surgery on the rise for obese teens. 25-Aug-2013 \"If the child is showing comorbidities like diabetes and hypertension, has reached puberty and achieved certain growth milestones then su

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Obesity prompts more cases of bariatric surgeries. 28-Jul-2013 \"By 2020 we will become the diabetic capital of the world. Its alarming.\" says Dr. Parveen Bhatia, Chairman of iMAS at Sir Ganga Ram H

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Hernia

What is Hernia?

  • A hernia occurs when 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 tyre, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac.

  • Both men and women can get a hernia.

  • You may be born with a hernia (congenital) or develop one over time.

  • A hernia does not get better over time, nor will it go away by itself.

How do I know if I have a hernia?

  • The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).

  • You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.

  • Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact your physician or surgeon.

  • Bulge may disappear on lying down.

What causes a hernia?

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 present from birth. Anyone can develop 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.

Types of hernia

  • Inguinal hernia- Direct/ Indirect

  • Femoral Hernia

  • Ventral Hernia-

  • Incisional-It arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. This can allow a loop of intestines or other abdominal contents to push into the sac. Incisional hernias occur in people who have had previous abdominal surgery, and are more likely to occur in people who are obese or pregnant. Incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall. Excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, straining during bowel movements because of constipation, severe vomiting, or chronic

    and intense coughing causes the scar tissue to thin or stretch. Because the abdominal wall is weak, the hernia occurs during abdominal strain.

  • Umbilical- An umbilical hernia is a condition in which a defect or hole exists in the abdominal wall at the level of the umbilicus (belly button). Skin overlies the defect and bulges especially during straining. During fetal development, the region of the umbilicus is very important. It is the point where the structures that make up the umbilical cord pass. This defect usually closes shortly after birth through natural processes. Occasionally the process of closure does not finish, and there is a persistent defect in the abdominal wall, or an umbilical hernia. Even if an umbilical hernia is present in infancy, most (90%) will close within the first year or two of life A few will persist into early childhood, prompting surgical referral.

  • Epigastric-An epigastric hernia is a hernia in the epigastric region of a human.It commonly is found in neonates (babies). Typically there is a small defect of the linea alba between the rectus abdominis muscles. This allows tissue from inside the abdomen to herniate anteriorly.

How is Hernia Treated?

  • Hernias usually need to be surgically repaired to prevent intestinal damage and further complications.

  • Use of a truss {hernia belt} is rarely prescribed as it is usually ineffective.

  • Surgical procedures are done in one of the two fashions:-Your surgeon will determine the best method of repair for individual situation:-

    The open approach is done from the outside through a three or four inch long incision in the groin. The surgeon may choose to use a small piece of surgical mesh to repair the defect.



    The laparoscopic hernia repair In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a trocar, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other trocars are inserted which allow your surgeon to work “inside.” Three or four quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.

Are you a candidate for laparoscopic hernia repair?

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or underlying medical conditions.

What is a mesh ?

  • MESH Surgical material, made from synthetic plastic(ie: Polypropylene) or gortex) or even biodegradable substances, used to repair hernias. These sterile mesh “SCREENS”, or “PATCHES” are soft, pliable, flexible, and ‘wafer-thin’ so as to conform to body movement and size. Yet they are remarkably strong to immediately add strength and fully repair the hernia while allowing rapid resumption of “normal” activities, including SPORTS. Many varieties, shapes and sizes of Mesh Systems are available. Hernias differ from patient to patient, and we firmly believe that any given single mesh system or manufacturer is not appropriate for effective repair of all hernias. We therefore, evaluate the anatomic and physical properties of each hernia at the time of surgery, then use our expertise to select the appropriate mesh form and TENSION FREE TECHNIQUE to satisfactorily repair your hernia defect appropriately.

What happens if the operation cannot be performed or completed by the laparoscopic method?

  • In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

  • The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation.

  • When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

What should I expect after surgery?

  • Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.

  • With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.

  • You are encouraged to be up and about the day after surgery.

  • With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.

  • Call and schedule a follow-up appointment within 2 weeks after your operation.

  • Strenuous activity and exercise are restricted for 2 to 4 weeks after surgery.

What complications can occur?

  • Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.

  • There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.

  • Difficulty urinating after surgery is not unusual and may require a temporary tube into the urinary bladder for as long as one week.

  • Some time a hernia that is repaired can come back. This long-term recurrence rate is not yet known, but is negligible after a mesh repair. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.

  • Swelling of the testicle or scrotum which is usually treated conservatively.

Is it risky for people with other medical problems like diabetes, hypertension & morbid obesity?

  • Not at all. On the contrary, absence of major trauma to the body causes minimal disturbance of normal physiology. Hence, there is no risk of aggravation of other conditions.

What are the other procedures that can be done laparoscopically?

Almost every organ in the human body has become accessible to the surgeon and MIS can be applied to most of the surgical procedures. Some of the conditions for which Minimally Invasive Surgeries are commonly performed are:-

  • Abdomen - Gall bladder stones, Appendicitis, Gastro – intestinal ulcers, Rectal prolapse.

  • Hernia – Inguinal, Umbilical, Epigastric, Femoral& Incisional.

  • Urinary System- Urinary stones, Enlarged prostate, Bladder cancer.

  • Bones & joints.