HERNIA

 HERNIA

Introduction

A hernia is a protrusion of internal organs through an irregular breach in the cavity's wall. 

This disease is caused by a combination of increasing internal pressure and wall weakening.

Internal organs or pieces of organs protrude out, causing a swelling that grows in size with coughing, lifting weight, and passing stool or urine. Except for strangulated and irreducible hernias, swelling enters the body when lying down.

Causes:

1. Weakness in body wall:

a) Congenital weakness.

b) Weakness caused by accidents, muscular atrophy, suppurative lesions in the wall, the existence of weak natural apertures, obesity, a lack of activity, or repeated pregnancy.

c) A surgical procedure including poor suturing or sepsis of the operative site.

2) Increased internal pressure.

a) Chronic constipation.

b) Recurring cough.

b) Weightlifting.

d) Urinary stricture.

Common places for hernias:

Hernias can arise anywhere on the body. However, there are a few prevalent hernia sites. 

Because of the presence of hard bone covering, the chest wall is usually unaffected. 

Lower back hernias are also uncommon due to strong spine and back muscles, as well as tough ligaments and sheeths.

Hernias are most commonly found on the abdominal wall. 

The abdominal wall is weaker than other regions because it has several natural orifices.

 Some places have weaker and thinner abdominal muscles, which increase the risk of herniation.

 The most prevalent hernia sites are as follows.

 a) The inguinal hernia:

The abdominal contents emerge through the inguinal canal (a channel in the lower abdominal wall right above the inguinal ligament).

 It may be seen from any side. This kind is widespread among males. Initially, the swelling appears solely when exerting and returns when lying down.

 Later, a substantial piece of the intestine may emerge, making it difficult to return.

 b) Femoral hernia:

This type of hernia is more common in females. 

The abdominal contents move through the femoral canal, which is visible immediately below the junction of the thigh and lower abdominal wall. 

The contents flow downwards and emerge through a saphenous aperture in the thigh, forming a swelling beneath the skin.

c) An umbilical hernia:

This is prevalent among children. The umbilicus is the weakest region of the abdomen. During sobbing and defecation, the contents of the abdomen may emerge as a bulb-shaped bulge.

 

d) Incisional Hernia:

These hernias are commonly found in operated areas. Due to poor suturing or infections, the surgical site weakens, resulting in a hernia.

e) Epigastric Hernia:

.The herniation occurs in the epigastrium. It's a rare type

f) Lumbar hernia:

.The hernias develop on either side of the lumbar spine (in the lumbar triangle). This is also a rare kind

:g) Obturator hernia

This is an uncommon kind of hernia. The contents pass through an obturator foramen in the pelvic bone

 

Complications of Hernia:

1) strangulation:

If the hernial aperture is narrow, the abdominal contents may not return freely, and blood supply to the herniated tissues may be obstructed due to constriction.

 This can result in mortality of the protruded intestine.

2) Intestinal Obstruction:

This occurs when a whole piece of the intestine protrudes into the hernial sac. 

The limited hernial hole will prevent the movement of the bowels.

3. Infection and peritonitis:

Strangulation with the death of a part of the intestine causes infection to move to the abdomen, resulting in peritonitis.

Treatment for hernia:

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

1) Use of a hernia belt:

There are special hernia belts for each form of hernia. This will prevent the protrusion and relieve pain.

2) Constipation, persistent coughing, urinary blockage, and other symptoms should be treated.

3) Reducing fat will strengthen the abdominal wall.

4) Abdominal workouts to improve muscle tone.

5) Eat enough of leafy vegetables, fruits, and fiber foods for regular bowel movements.

6) Try other systems, such as homeopathy, herbal medicine, and so on.

If the preceding steps do not provide relief, consult with a general surgeon about surgical options.

Surgical therapy:

The following surgeries are performed based on the type and nature of the hernia.

1) Hertiotomy: During this procedure, the contents of the hernial sac are forced into the abdomen, and the neck of the sac is ligated using a transfixion ligature before the sac is cut off.

2) Herniorrhaphy: Along with the herniotomy, the posterior wall is repaired.

3) Hernioplasty: This operation is performed when a herniotomy is not possible due to the sac's broad neck. The repair is done using non-absorbable materials such as tantalum gauze, polypropylene mesh, or stainless steel mesh.