Saturday, December 6, 2014

HERNIA:WHAT IS HERNIA?WHY AND WHEN SHOULD IT BE TREATED?


Hernia
hernia is the protrusion of an organ or portion of an organ through the wall of the cavity that normally contains it. The inguinal canal is found in the groins of both men and women. In men, it is the area where the spermatic chord passes from the abdomen to the scrotum. This chord holds up the testicles. In women, the inguinal canal contains a ligament that helps to hold the uterus in place.


There are different kinds of hernias, each requiring a specific management. By far the most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or "defect", through which omentum, or abdominal organs covered with peritoneum, may protrude in the form of hernia.


Hernias may or may not present with either pain at the site, a visible or palpable lump, or in some cases more vague symptoms resulting from pressure on an organ which has become "stuck" in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed or accompanied by an organ. protrude.


Symptoms and signs vary depending on the type of hernia. Symptoms may or may not be present in some inguinal hernias. In the case of reducible hernias, a bulge in the groin or in another abdominal area can often be seen and felt. When standing, such a bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area.


Irreducible abdominal hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation (loss of blood supply) and/or obstruction (kinking of intestine). Strangulated hernias are always painful and pain is followed by tenderness. 
  The conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination (constipation, enlarged prostate), chronic lung disease etc.

Also, if muscles are weakened due to old age,poor nutrition,multiple pregnancies,previous surgeries on abdomen etc. hernias are more likely to occur.
By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. Inguinal hernias are further divided into the more common indirect inguinal hernia (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal.
UMBILICAL HERNIA:They involve protrusion of intraabdominal contents through a weakness at the site of umbilicus through the abdominal wall. Umbilical hernias in adults are largely acquired, and are more frequent in obese men and women. Abnormal decussation of fibers at the line alba  may contribute.Umbilical hernia occurs in babies under 6 months of age which becomes obvious when the baby cries.Typically, this hernia goes away on its own by 1 year of age.







Surgery is usually recommended for most types of hernias to prevent complications like obstruction of the bowel or strangulation of the tissue,Muscle reinforcement techniques often involve synthetic materials like mesh. The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times staples are used to keep the mesh in place. 
Laparoscopic surgery is also referred to as "minimally invasive" surgery, which requires one or more small incisions for the camera and instruments to be inserted, as opposed to traditional "open" or "microscopic" surgery, which requires an incision.Many patients are managed through day surgery centers, and are able to return to work within a week or two, while intense activities are prohibited for a longer period. 



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