A- The surgical treatment is the definitive and best treatment option available till date and in the future also. No medicine can bridge the gap/weakness in the abdominal wall.
Given the opportunity to repair them in planned setting, it can done either by open approach and more advanced the laparoscopic approach. Be it open or laparoscopy a mesh needs to be used to bridge the gap and give strength to the weak abdominal wall. Meshes come in various dimensions, quality and cost. The decision to use the best suited one is only after a complete check in the OPD.
Q – Ok, I have it. Now what? Would those Ayurvedic pills work on it?
A – Hernias occur through weakness in the abdominal wall and this weakness needs reinforcement and that to a mechanical one! A healthy diet, maintaining good weight and regular exercise helps in prevention in recurrences after you are operated.
Q – Where shouldI I get myself checked?
A – Meet a Surgeon. Making a diagnosis of hernia is purely clinical. Your doctor might refer you for a sonography for a simple one and a CT scan if they suspect it to be of complicated nature.
Q- Why should I seek medical attention for calmly sitting hernia?
A- Hernias are known to complicate And all this complications come uninvited.
The content of the hernia usually moves to and fro from the abdominal cavity to the hernia sac but unfortunately in bad time hernia can get obstructed. The content may not go back into the abdominal cavity and its function might get hampered. If its intestine then may land up in an entity called as intestinal obstruction. Worst case scenario, the intestines can die in it too!
Q- How can a hernia affect my lifestyle?
Most people consult doctors for either a swelling which is gradually increasing in size or Pain.
The unsightly swelling can cause disfigurement of the body , poor fitting of clothes, restrict your athletic ability ,affect sexual function and what follows next is low self esteem!
Pain, distressing of all symptoms can be nagging or dragging type to begin with and can later progress to constant colicky type if the hernia complicates.
Q- Where all can a human get hernia?
A- Practically everywhere! But I would like to tell you all about ABDOMINAL WALL hernias.
The abdominal wall hernias can be of various types!
The Abdominal wall, is sheet of tough muscles and fascias and tendons that runs down from rib cage to the origin of legs and act as a corset.
Groin hernias are the most common of all abdominal wall hernias. The one most of you have seen or heard of, the one which every weightlifter is scared of!
To be specific these groin hernias are called as INGUINAL and FEMORAL hernia. Inguinal is further classified into two, Direct and Indirect hernia.
Indirect hernias occur through a natural point of weakness which is called as The INGUINAL CANAL (connects the scrotum to internal abdominal cavity). Everyone has this canal but not everyone has this hernia! When kid is in the womb the testis descends down through this canal from abdomen to the scrotum and may leave behind a patent tract which in future leaves a hassle free entry port for the organs (mostly intestine and omentum- the fat curtain) to descend outside the abdominal cavity into the canal or scrotum.
Direct hernias occur through an acquired weakness in the abdominal cavity muscles namely through the Hasselbach’s triangle.
Femoral hernias also occur through a natural orifice in the abdominal cavity that connects the lower abdomen with the upper thigh.
Apart from these groin hernia there are other types of hernia that occurs in varying frequency but needs equal attention. These are –
Umbilical hernia – through the navel.
Epigastric hernia – through weakness of upper abdomen.
Lumbar hernia – through the muscles of lower back.
Spigelian hernia – through the flat muscles of the abdomen, side aspect.
Incisional hernia – occurs through acquired defect or weakness, the incision of previous surgery.
We would like to bring your attention to a special type of hernia which mandates special care and early attention to seek medical care – the hiatus hernia!
This is the type of type of hernia where abdominal organs namely oesophagus and stomach ascends into the chest cavity without any external swelling!!! Only the sufferer understands the agony associated with it which is the heartburns and regurgitation……
Q- Why do we get Hernias?
A- Hernias occur through either natural or acquired weaknesses in the abdominal wall. The abdominal wall is fashioned in such a way that it holds the abdominal organs inside in the abdominal cavity but there are places of natural weakness in this wall which can predispose a person to have hernia/hernias. There are certain factors which can increase the risk of a person having hernia viz. Obesity, poor nutrition, smoking, previous surgery, constipation, persistent cough ,overexertion and people who sit in front of computers all day long!
Q- So what exactly does hernia means?
A- The word hernia comes from Latin word hernia which means “RUPTURE”. In our modern day society I would like explain hernia as an abnormal protrusion of an organ from the body cavity that contains it to another/outside world.
How much weight will I lose and how long will it take before I see the effects?
After certain procedures, the weight loss can be dramatic: it is normal for people who have had some types of operation to lose tens of kilograms in the first year.
However, everybody’s journey is different. Some people lose weight very quickly and for others it can take longer. People who have had weight loss surgery do not continue to lose weight indefinitely. Although weight may continue to fall 12-18 months or more after surgery, the body adapts to the changes in the digestive system.
You also need fewer calories as you get lighter. These factors help weight to stabilise in the weight.
What will be the long term impact on my life?
Choosing to have weight loss surgery is a life changing decision. You may find after your procedure that some foods may be more difficult for you to digest and you may find you need a smaller amount of food to fill you up.
Losing excess weight can help resolve or reduce the symptoms of a number of conditions including type 2 diabetes, hypertension and sleep apnoea. It can also help reduce the risk of developing diseases associated with being very overweight.
Many past patients who’ve had weight loss surgery tell us it has had a positive impact on their lives. They feel more confident, have more self esteem, more energy and are happier and healthier. They feel like they’ve got their life back, are now living the life they want and looking forward to the future..
Will there be any psychological support?
NICE guidance on surgery for obesity recommends that psychological support should be available to patients before and after surgery. You may be asked to complete an assessment to establish whether you have any psychological issues related to eating as after your surgery the type and amount of food you can eat will change. You may also be offered counselling to help change your diet and lifestyle and attending a weight loss surgery support group may be recommended to provide further psychological support.
Can you tell me about a weight loss surgery support group?
Many people find that joining a group of weight loss surgery patients provides valuable motivation and support, both before the operation and during the period of adjustment after surgery.
Some of our hospitals run support groups where patients can get together to share their experiences. It can be useful to talk to people that have had the same operation so you can ask questions and see how they coped with any difficulties you may have adjusting to life after weight loss surgery.
Ask your local Spire hospital to put you in touch with a support group either in the hospital or the surrounding area.
Will I have excess skin after I’ve lost weight?
If you lose a lot of weight you may find that you have excess skin and you may wish to consider cosmetic surgery. Some people choose to have an abdominoplasty or a breast or body lift following weight loss surgery.
Please ask your clinical team for more advice, they will be happy to discuss options with you.
Will I need to exercise?
As your weight begins to fall, it will become easier to get about and increase your levels of physical activity. Burning up energy through physical activity, such as walking or resistance exercise (for example, weight training), will make it easier to get to your target weight and help reduce fat and tone muscles.
Since your body will need time to heal after surgery you should take it gently to begin with and gradually build up your activity. Ask the physiotherapist at the clinic for more information.
Will I have any follow-up appointments?
Follow-up visits to your surgeon and/or dietitian will be required.
If you have had a gastric band fitted you will be asked to come back into hospital so that adjustments can be made to the band if necessary. You may need three or four adjustments in the first year after the operation and ongoing follow-up.
Follow-up will be key to the success of your operation. Not only is it important to check that the operation has been successful, it is important to give you all the support you need and to give you the opportunity to ask questions.
With your consent, your surgeon will also let your GP know that you have had weight loss surgery.
How will my diet change?
The changes that are made during surgery will require permanent changes in your eating habits if the operation is to be a success. Ongoing support from a dietitian, specialist nurse and patient support group can be very helpful.
The exact diet you will need to follow in the days after your surgery will depend on your procedure. Your surgeon and dietitian will give you advice and dietary instructions for after your surgery. In general you will not be able to eat any solid food at all in the first couple of weeks after surgery and will need to follow a liquid only diet. This is because surgery causes swelling that needs to reduce to allow food to pass properly.
Most people start on liquids and move on to puréed and then solid food. The rate of progression through these stages is different for each person and you should follow your surgeon’s advice.
What happens when I go home?
Before you go home, your nurse will give you advice about caring for your healing wounds, hygiene and bathing. Your nurse will also give you a telephone number for the clinic, in case you need to ask for further advice.You will be given a date for a follow-up appointment with your consultant.
What will happen after the surgery?
After surgery you will be taken from the operating theatre to the recovery room, where you will come round from the anaesthesia under close supervision.You may be taken to a high dependency unit where you will be closely monitored. You will be connected to machines that monitor the activity of your heart, breathing and other body systems.Once the medical team is happy with your progress, you will be taken back to your room. A nurse may continue to monitor your blood pressure, heart rate and breathing at regular intervals.The length of time you need to stay in hospital will depend on the type of surgery you have. For example, gastric banding is sometimes undertaken as a day-case (with no overnight stay) but usually involves a one night stay in hospital. Patients who have a gastric bypass or sleeve gastrectomy generally stay in hospital for three or four nights following their surgery while a duodenal switch can involve a stay of five or six nights.
What will happen when I come in for surgery at the hospital?
When you arrive at the hospital, your nurse will do some simple tests such as checking your heart rate and blood pressure. You may be asked to wear compression stockings to help maintain circulation and reduce the risk of blood clots forming in the veins of your legs (deep vein thrombosis, DVT). You may also be given an injection of a blood-thinning drug before surgery.Your specialist nurse will discuss the effects of surgery and the changes to your lifestyle and eating habits.Your surgeon and anaesthetist will also visit you before the operation. This is a good time to ask any unanswered questions.
What will happen before the surgery?
Before you come for surgery you will have had a consultation with your weight loss surgeon where he or she will discuss your options and the most appropriate procedure for you.You will also meet with the dietitian at the hospital to discuss the changes you need to make to your diet before and after the operation. In some cases you may also meet with other members of the specialist bariatric team and you may be invited to attend a bariatric support group to help you prepare for surgery.You’ll then attend an appointment at a pre-operative assessment clinic. A number of blood tests will be taken and your nurse will complete a range of assessments to assess your fitness for surgery and to ensure plans are put in place to reduce any additional surgical risk identified at the assessment. You may also need to start a special diet designed to reduce the size of your liver so your surgeon can perform your operation more easily.