Hernia

A hernia is a medical condition in which an internal organ protrudes through a weak spot in the tissue or muscle. Most hernias occur within the abdominal cavity, between the chest and the hips. The most common types of hernias are inguinal hernia, femoral hernia, umbilical hernia, and hiatal hernias. Inguinal hernia is the most commonly occurring hernia. In an inguinal hernia, the fatty tissue or part of the intestine protrudes from the top of the inner thigh.

Inguinal and femoral hernias are located at the top of the inner thigh near the groin. Umbilical hernias are located near the belly button, whereas hiatal hernias occur near the chest area.[

Hernia

1. A Hernia is a medical condition in which an internal organ protrudes through a weak spot in the tissue or muscle.
2. Most hernias occur within the abdominal cavity, between the chest and the hips.
3. The most common types of hernias are inguinal hernia, femoral hernia, umbilical hernia, and Hiatal hernias.
4. Inguinal hernia is the most commonly occurring hernia.
5. In an inguinal hernia, the fatty tissue or part of the intestine protrudes from the top of the inner thigh.
6. Inguinal and femoral hernias are located at the top of the inner thigh near the groin.
7. Umbilical hernias are located near the belly button, whereas Hiatal hernias occur near the chest area.

Causes 

1. Femoral and inguinal hernias occur because of weakened muscles. This muscle weakening can be present since birth or due to ageing or repeated strain on the abdominal or groin area.[1] This strain can result from:
2. Frequent coughing 
3. Obesity 
4. Pregnancy
5. Straining on the toilet because of constipation
6. Adults can develop umbilical hernia due to abdominal pressure resulting from being overweight, after giving birth or having persistent heavy cough.
7. The weakening of the diaphragm (a muscle that separates the chest from the abdomen) with age or pressure on the stomach could be responsible for causing a hiatal hernia, although the exact cause is not yet fully understood.

Signs and Symptoms 

1. A hernia of the abdominal or groin region will produce a noticeable lump that disappears when lying down. Activities like laughing, crying, coughing, and straining during a bowel movement may make the lump reappear. 
2. Also, an inguinal hernia can produce different symptoms in men and women.

Symptoms in men 

1. Pain that worsens due to activities that put pressure like heavy lifting, straining and pushing
2. Visible bulge 
3. Feeling of pressure at the site 
4. A pulling sensation of the scrotum around the testicles
5. Symptoms in women 
6. Sharp pain
7. A bulge or protrusion at the site of the hernia (may be absent in a groin hernia)
8. Discomfort that worsens with activity 
9. Burning sensation

In a hiatal hernia, symptoms include indigestion, heartburn, frequent regurgitation, and difficulty swallowing. No bulges on the outside of the body are visible.[1]  

In the case of umbilical hernia, symptoms include: 

1. Constipation
2. Abdominal pain 
3. Fullness in the abdomen
4. Fever 
5. Vomiting 
6. Purple, red or discoloured bulge
7. Femoral hernias don’t present any symptoms most of the time. Sometimes, the symptoms mentioned below might be present: 
8. Abdominal pain
9. Sudden groin pain
10. Vomiting 
11. Nausea

Diagnosis 

1. Doctors usually ask about medical history and symptoms, followed by a physical examination. 
2. The doctor will check your abdomen during the physical examination while you are asked to cough.
3. In cases where physical examination is not conclusive, doctors might prescribe several imaging tests such as:
4. Computed tomography (CT) scan 
5. Ultrasound 
6. Magnetic resonance imaging (MRI)
7. These tests can accurately diagnose a hernia by soft tissue and organ imaging. These imaging techniques are also prescribed to examine complications of hernia if any.

Treatment  

1. Hernias require surgical intervention as, in most cases, they are not cured independently. The surgeon evaluates if surgery is needed and will suggest a method best suited to you.
2. In the case of an umbilical hernia in a child, surgery is recommended if the condition does not improve till the age of four to five years or if the hernia is large.
3. There are three types of surgical options for hernia treatment: 
4. Open surgery: A cut is made at the hernia’s location, the protruding tissue is placed back at its place, and the cut is stitched back together. The surgeon might implant a mesh at the site to support the weekend muscle.
5. Laparoscopic surgery: The repair procedure is the same as that of open surgery, but tiny cuts are made in the place of a cut to the outside of the groin or abdomen to allow the insertion of surgical tools.
6. Robotic Hernia repair: Robotic surgery is performed using a console by which the surgeon controls the instruments. It is used for small hernias and can also be used to reconstruct the abdominal wall.
7. Your surgeon will prescribe the method that is best suited to your condition. After the surgery has been performed, the surgeon will give you a set of instructions to follow. These instructions involve the kind of diet to follow, how to look after the incision, and avoiding activities that strain the operated site.

1)Laparoscopic inguinal hernia repair (LIHR) has the following advantages 

1. less postoperative discomfort and pain,
2. reduced recovery time that allows earlier return to full activity,
3. easier repair of a recurrent hernia because the repair is performed in tissue that has not been previously 

2)The open surgical repair of primary inguinal hernias is better than the laparoscopic technique for mesh repair,.