WHAT’S NEW IN HERNIA?
“HERNIA IS NOT A MEDICAL CONDITION”
Anyone, who is diagnosed to have a hernia, would need a surgery sooner than later, as it is a breach in the tissue, which can ONLY be repaired surgically.
The weakness will predispose the internal organs to protrude out. If there is an excess pressure then it may create a problem and the internal contents can be become entangled or incarcerated in a hernia. The weakness in the muscles could be present from birth or can develop with age. Once there is a weak spot in the muscles, any factor that puts a strain on the muscles can cause the development of a hernia. According to our expert hernia surgeon in Dubai, common factors predisposing to hernia formation are:
- Incessant Coughing
- Heavy Weight Lifting
- Increase in Weight
What is Incisional Hernia:
“When a hernia occurs at a place where another surgery or operation has taken place before.”
This occurs due to the complications after abdominal surgery. After a surgeon cuts through abdominal muscles to operate in the abdominal cavity, the area usually heals but weak spots can remain within the scar. This is the most common cause of larger sized hernia of the abdominal wall. The incision can be taken for a cesarean section or for some major surgery in the past. The Hernia surgeon has to evaluate the strength of the muscles which from the covering of the major internal organs and repair them in a manner, that a hernia is not formed again and at the same time there is no further damage to the intestines. They also have to ensure the stability of the spine and determine that the movements of the trunk are not affected.
What are the Symptoms of Hernia?
- Abnormal lump or swelling is formed in the area of the previous incision.
- Pain in the lump while coughing
- Increase in size of lump while standing or on coughing
“A Hernia should not be ignored and needs to be treated. Hernia can be treated only by surgery. Surgery essentially involves repairing the defect in the abdominal wall, belly button or groin through which hernia has developed.”
An untreated hernia can enlarge over a period of time. More importantly, if a portion of the bowel protrudes into the hernia sac, it can get twisted and trapped thus leading to blockage of the bowel. This condition is known as obstructed or strangulated hernia. This is an emergency situation requiring an urgent surgery.
“Surgical Repair of the hernia is a technically challenging and a scientific process. The end result is measured in terms of functionality, cosmesis, pain score after the surgery and recurrence.”
“A good hernia repair is one, which is done without breaching the tissue planes and preserving the integrity of the muscles or realigning and restoring with or without re-enforcement in a manner that they function at their best”. The change in the pressure dynamics adapting to the nature of the work will prevent recurrence at the site of the repair.
FEMALES WITH ABDOMINAL HERNIA AND LOOSE MUSCLE TONE
In females who are overweight and develop an abdominal hernia, a simple repair of the hernia may not take care of the excess tissue and fat in the abdominal wall. There is a higher rate of recurrence of the hernia also. In such situations hernia repair may have to be accompanied by bariatric surgery in morbidly obese patients or Abdominoplasty (tummy tuck) in normal or mildly overweight patients. Bariatric surgery is important for overall long term benefits whereas tummy tuck is a cosmetic surgery. Tummy tuck is useful in ladies who develop hernia during pregnancy and have a very lax abdominal wall with poor muscle tone after childbirth. Our experts in Hernia Repair Surgery in Dubai commonly perform Abdominoplasty to reshape the abdominal wall and firm up the covering skin and tissues.
THESE PATIENTS NOT ONLY HAVE FAT OVER THE MUSCLES BUT SOMETIMES THERE IS A WEAKNESS IN THE AREA BETWEEN THE TWO RECTUS MUSCLES: THIS DEFECT IS KNOWN AS “DIASTASIS” OR “DIVARICATION”. Previously it was thought that diastasis is normal and cannot be corrected or more so that it is a cosmetic procedure. But in due course of time it has become evident that diastasis causes destabilisation of the spine and can be a cause of severe back pain. The diastasis was graded according to the distance between the two muscles at the widest point. The larger the diastasis; higher the chances that it will not improve with abdominal exercises and needs a surgical collection.
There are endoscopic and laparoscopic methods to correct the diastasis and also to strengthen and repair the midline. It has been found to have remedial effect on the anterior bulge and also significantly improved the back pain and strain on the lumbar muscles.
The endoscopic method is know as e-TEP “Enhanced – Totally Extra Peritoneal” Repair.
The other method is to create a subcutaneous plane and approximate the rectus sheath “SUCUTANEOUS ON LAY APPROXIMATION” (SCOLA) AND MESH
“Our hernia repair experts in Dubai specialize in Laparoscopic hernia repair and have one of the largest experience in this surgery in the Emirates”
WHAT IS THE BENEFIT OF LAPAROSCOPIC HERNIA REPAIR (IS IT BETTER?)
Laparoscopic Hernia Repair has fast emerged as a preferred mode of hernia surgery in the U.A.E. for treatment of all forms of hernia. This requires 3-4 small incisions made in the abdominal wall, through which the surgeon performs the operation. The major benefits of the laparoscopic hernia repair surgery are:
- Incisions made are relatively small; making it a painless technique.
- No scars are seen after surgery.
- Very effective in treating hernia in the groin region.
- As mesh is used for reinforcement, there is less chance of the hernia recurring.
- Short recovery time.
Laparoscopic procedures are used for groin hernia and for ventral hernia
For groin hernia, the surgery can be done by going all the way into the peritoneum or by limiting oneself into the layers of the abdominal wall only. The surgery for ventral hernia is more intense because it uses a mesh which is placed inside the abdomen to cover the defect from the inside. This is also known as IPOM (Intra Peritoneal Onlay Meshplasty). There are various modifications of this technique, which include the closure of the defect prior to placing the mesh (IPOM Plus).
WHAT IS AWR (ABDOMINAL WALL RECONSTRUCTION)
RAW (reconstruction of abdominal wall):
Surgical techniques are evolving to focus on restoration of abdominal wall function along with structure as well. Reconstruction of Abdominal wall with mobilisation of autologous tissues has evolved as a reliable option for patients with incisional hernias.
THIS IS NOW A WHOLE NEW CONCEPT IN PRACTICE AND NOT JUST IN EVOLUTION. The muscles of the abdominal wall have an important role to play in the movement of the body, for respiration and for stabilisation of the spine. Any disruption in the integrity of the wall indirectly affects the function of these systems.
Large ventral and incisional hernia:
These are caused due to incompletely healed surgical wounds and have a high recurrence rate if repaired with a simple suture technique. The new tension-free method being used involves the sewing of surgical mesh patches well beyond the edges of the weakened area of the abdominal wall using laparoscopic approach. As the area heals, the mesh becomes firmly integrated into the inner abdominal wall membrane diminishing the risk of recurrence.
The technique of AWR (Abdominal wall reconstruction) involves a process called TAR (release of transversus abdominis muscle) to be able to create more space and place a mesh according to the size of the defect.
WHAT IS ENDOSCOPIC OR LAPAROSCOPIC COMPONENT SEPERATION
Component Separation technique:
This provides tensionless closure of large, full thickness frontal abdominal hernia with autologous tissues, made from prosthetic materials. It is now, being used for treatment of large ventral hernias and intractable abdominal hernia. Advantages of this technique are:
- Restore structural and functional integrity of the abdominal wall.
- Provides stable soft tissue coverage.
- Optimises aesthetic appearance.
If you are suffering from Abdominal Hernia, don’t think twice before visiting our centre to get expert advice on hernia surgery in Dubai and get detailed information about modern techniques of hernia repair.
INTERNATIONAL HERNIA COLLABORATION
It is a group of surgeon who have a special interest in the management of hernia. They discuss the cases, which have a difficult solution and make decisions after consulting the worldwide experts in this area. It helps to eliminate or minimize the sufferings of the patient. If gives a standardized surgical solution that is acceptable to all surgeons. The trust of the patient increases. The outcome improves. The complications decrease. Patients benefit and surgeon benefits.