Tuesday, December 12, 2023

Hernia – its prevention, care and cure

On 16 April, 2023, Seniors Today hosted the weekly Health Live webinar with Dr Kona Lakshmi Kumari, who spoke on and answered questions about Hernia- its prevention, care and cure.

About Dr Kona Lakshmi Kumari:

Dr Kona Lakshmi Kumari is a Consultant Surgical Gastroenterologist, Minimal Access GI Surgeon, and Metabolic & Bariatric Surgeon at Yashoda Hospitals, Somajiguda, with over 24 years of experience. She has performed over 25,000 minimal access and more than 3000 bariatric procedures. She has performed the highest number of single incision scar-less bariatric surgeries in the states of AP and Telangana. She has worked at NUH, Singapore and also at Cleveland Clinic, Ohio, USA

She graduated from S.C.B Medical, Cuttack, with her MBBS in 1992 and her MS (General Surgery) in 1997, respectively. She received her training in bariatric surgery at the Cleveland Clinic in Ohio, USA, as well as NUH in Singapore.

Dr Lakshmi enjoys mentoring newcomers to minimally invasive surgery and has a keen interest in academics and research. She also actively participates in a number of medical forums and conferences. She served as the organising secretary for OSSICON in 2009 and FIAGES, Hyderabad in 2010 and 2012 while also serving as the vice president of IAGES, Central Zone from 2008 to 2010 and again in 2010 to 2012.

Special Interest and Expertise:

  • Minimal Access Bariatric Surgery
  • Minimal Access Surgery
  • Laparoscopic Hernia Repairs (Inguinal, Incisional, Ventral Hernias & Redo Hernias)
  • Laparoscopic Upper Gastrointestinal Surgeries

Hernia is a very common surgical issue/ problem. And it is slightly more common in the elderly group of population.

Hernia is an abnormal protrusion of the abdominal contents through any weakness in the muscles of the abdominal wall. These can be small or big and depending on the site of protrusion/ swelling, we name them differently such as –

  • Epigastric hernia- in the upper abdomen
  • Umbilical hernia- around the belly button
  • Inguinal and femoral hernia- near the groin region
  • Incisional hernia- around any old/ previous scars

The abdominal wall muscles around these regions become weak either due to primary weakness in the abdominal muscles, secondary to surgery, weakness due to chronic cough, constipation, or the individual is obese or very thin- any one or more than one of these can aid and lead to protrusion of the intestines, leading to hernia.

Causes for hernia:

  • The most common cause for hernia is muscle weakness. We may appear healthy and fit from outside, but our muscles might not be strong enough, due to lack of certain proteins.
  • Raise in the intra-abdominal pressure either due to obesity, multiple pregnancies, chronic cough and individuals who lift very heavy weights in an untrained muscles
  • Trauma to the abdomen

In the olden days, when laparotomies were more common than laparoscopic surgeries, the incision sites used to be big, and invasive as opposed to the now, minimally invasive laparoscopic surgeries. These laparotomy scars could cause a weakness in the abdominal muscle, later giving rise to incisional hernia at the site of incision. 30-40% of the patients who have undergone laparotomy, develop an incisional hernia later in their lives.

Females are at higher risk of developing femoral hernia which is a weak area in your groin region. The risk of femoral hernia is higher in females than males. Bowel entrapment is also a common consequence seen in patients with femoral hernia.

Males are at a higher risk of developing inguinal hernia. This is because the reproductive structures that pass through the weak area, inguinal canal, into the scrotum, creating a weak pressure zone.

Umbilicus is also a weak area, and umbilical and paraumbilical hernias are common in obese individuals, women with multiparty.

Atypical hernias are also seen, these arise at locations other than the aforementioned ones, where there is a weakness in the abdominal wall muscles, and is bound to lead to a hernia.

When a hernia develops, the intestinal contents protrude out from the weekend abdominal muscles and get entrapped between the wall and the skin. When the intestinal contents are large in amount, they can get trapped, obstructed and can also lead to torsion or twisting of the intestines.

A hernia needs to be repaired immediately. It is a surgical problem and cannot be treated medically.

Neglected hernia can have irreducibility-  which means that the hernial contents are not easily going back into the abdomen- this can lead to obstruction, incarceration and sometimes a change in the colour of the healthy and the obstructed intestine is also visible due to loss of blood supply leading to ischaemia of the intestine.

Neglecting a hernia or overlooking the swelling until it starts to “trouble you” is not the right approach to a hernia, as a patient.

The longer you live with a hernia, the higher are the chances of you landing up in the hospital as a surgical emergency. It is also seen that in cases of emergency hernia repair surgery, the results were not as good as the ones seen in patients being operated electively for hernia repair. This can be due to the increased risk of infection, reduced chances of using a mesh for repair due to the risk of infection, life etc.

If you have a hernia, or a visible swelling which is more than 1.5 cm in size, it is recommended that it be operated.

Depending on the location of the hernia, there are different names to the surgery for repairing a hernia. A mesh is usually used to strengthen the weakened muscles once the contents of the hernia sac are reduced back into the abdomen. After the contents are reduced, the mesh is placed and the abdominal is strengthened and closed.

Earlier, hernia repair surgeries were also involved giving a large incision, which led to prolonged stay at the hospital, delayed healing, etc. with the current medical advancements, there are laparoscopic and robotic surgeries with which the same results can be achieved, with minimal scarring and quicker healing.



Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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