HERNIA

 

Introduction

A hernia is an abnormal protrusion of internal organs through an abnormal opening in the cavity wall. Increased internal pressure and wall weakness combine to cause this condition. In this condition, internal organs or parts of organs protrude out, forming a swelling that increases in size when coughing, lifting weights, and when passing stool or urine. In the lying-down position, the swelling tends to move inside, except in cases of strangulated or irreducible hernias.

Causes:-

1. Weakness in the body wall:

a) Congenital weakness.

b) Acquired weakness due to injuries, wasting of muscles, superficial lesions in the wall, and presence of weak natural openings; obesity; lack of exercise; repeated pregnancy.

c) Surgical operation with improper suturing or sepsis of the operated site.

2) Increased pressure inside the body.
   
a) Chronic constipation.

b) Recurrent cough.

c) Weight lifting.

d) Stricture of urethra.

Common sites for hernia:

Hernia can occur anywhere in the body. However, there are common sites where hernias occur. The chest wall typically remains unaffected due to the presence of hard bony coverings. Hernias in the lower back are also rare due to the strength of the spine and back muscles, as well as the tough ligaments and sheets that support them. The common site for hernia is the abdominal wall. The abdominal wall is weaker than other parts due to the presence of certain natural orifices. There are certain areas where the abdominal muscles are weaker and thinner, which increases the risk of herniation. The following areas are commonly affected by hernias:

a) Inguinal hernia:

Here the abdominal contents protrude through the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament). It is seen on either side. This type is common in males. Initially, the swelling only occurs during straining and subsides when lying down. Later, a significant portion of the intestine may come out, and it may not return easily.
    
b) Femoral hernia:

This type of hernia is more common in women. The femoral canal, located just below the junction between the thigh and lower abdominal wall (inside the femoral triangle), is where the abdominal contents pass through. The contents descend and emerge through a saphenous opening in the thigh, resulting in a swelling beneath the skin.

c) Umbilical hernia:

This is common in children. The umbilicus is the weaker part of the abdomen. The contents of the abdomen may protrude as a bulb-like swelling while crying and defecating.

d) Incisional hernia:

These hernias are seen in operated sites. Improper suturing or sepsis can weaken the operated site, leading to the development of a hernia.
    
e) Epigastric hernia:

This type of hearing occurs in the epigastrium. It is a rare type.

f) Lumbar hernia:

In this case, the hernia manifests on either side of the lumbar spine, specifically in the lumbar triangle. This is also a rare type.

g) Obturator hernia:

This is a rare type of hernia. Here the contents pass through the obturator foramen in the pelvic bone.

Complications of hernia:

1) Strangulation:

If the herniated orifice is narrow, constriction may later block the blood flow to the herniated tissues, making it difficult for the abdominal contents to pass back through. This could potentially result in the protruded intestine dying.

2) Intestinal obstruction:

This happens when the entire intestine protrudes into the hernial sac. The narrow hernial orifice will block the passage of bowels.

3) Infection and peritonitis:

If a part of the intestine dies due to strangulation, the infection will spread to the abdomen and cause peritonitis.

Treatment of hernia:

Initial treatment: In the initial stages of hernia, the following steps may be useful:

1) Use a hernia belt:

For each type of hernia, there are specific types of belts available. This will prevent protrusions and reduce pain.

2) Treatment is necessary for constipation, recurrent cough, urinary obstruction, etc.

3) Fat reduction will increase the strength of the abdominal wall.

4) Abdominal exercises to increase muscle tone.

5) Take plenty of leafy vegetables, fruits, and a fibrous diet for effortless bowel movements.

6) Try other systems like homeopathy, herbal medicine, etc.

If there is no relief from the above steps, consult a general surgeon for surgical management.

Surgical treatment.

The type and nature of the hernia determines the following operations.

1) Hertiotomy: During this procedure, the surgeon pushes the contents of the herniotomy sac into the abdomen, ligates the sac's neck with a transfixion ligature, and then cuts the sac off.

2) Herniorrhaphy: This procedure repairs the posterior wall in addition to a herniotomy.

3) Hernioplasty: This operation is done if herniotomy is not possible due to the wide neck of the sac. Non-absorbable materials such as tantalum gauze, polypropylene mesh, or stainless steel mesh assist in this repair.

Location:

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