Medicus clinic

Hernia: Types, symptoms and treatment

Good Morning this is Dr. Nimesh Shah. I'm a Surgeon, endoscopic, laparoscopic and GI surgeon associated with Global Hospitals as a consultant and S.L Raheja Fortis Hospital. I have my own hospital at Dadar, Sanjeevani Hospital. I am going to talk about Hernia.

It is basically the protrusion of the abdominal contents of the abdominal walls that contains it. We are talking about external hernia right now so we will be talking about inguinal, umbelical, lumbar and incisional hernias. So inguinal hernias are hernias which occur in the groin region. They occur both in the males as well as females, however they are more prominent in males. They can be congenital or acquired congenital that is usually seen in the younger age group. Very rarely we see very large hernias in the adults which are congenital in nature which we come to know only during surgery. Congenital hernias are basically because of patent processes vaginalis which is the tract that takes the testis into the scrotum.

Anyway this is acquired in any age group, younger as well as in older people. Basically they occur because of msucle weakness or gaps between the muscle weakening because of sudden increase or sudden loss of weight and also due to lifting heavy weights. Now the umbilical hernias occur or are most commonly seen in individuals who are doing very hard physical labour. The other hernias are not so common. Incisional hernias are hernia which occur because of surgery. Any surgery in the past that becomes a weak area over the abdominal wall and this may give away over a period of time and you may get protusion of intestines or abdominal fat through that. Most often these are elective procedures. Very rarely a patient comes in emergency where the intestinal contents have come out and they are not going back, so they can become an obstracting hernia or very rarely they can become gangrenous and become strangulate hernia.

The investigation or clinical examination is the only way that this can be confirmed. It is very obvious even to the patients that there is a bulge which is not normal to that area. So that bulge reduces the line down. This is the most common symptom or complain that the patient comes with. Ultrasound maybe neccessary at times to confirm size of the defect. However, in small hernias like in the ingenial hernia the ultrasound maybe helpful in trying to pick up the sack. The main state of treatment remains surgery.

Surgery is an elective brand procedure, very rarely as I said in obstructed hernias it is an emergency where in the patient needs to be taken in as early as possible for the benefit of the patient. Surgeries can be done either with laparoscopy or open surgery. Open surgery has been done since time immemorial and various kinds of methods are used from fishnets to now polypropelyn to prevent recurrences of hernia. In the laparoscopic procedure three small holes are made and the hernial sac is reduced and the mesh is placed. For the other hernias there is a special mesh that can prevent lisons of intestines to the mesh however in the laparoscopic or inguinal hernia special polypropelyn mesh is used. Sometimes we even use a 3D mesh which takes the shape of the pelvis bone. It's usually fixed into place using takers which are screws made up of absorbale or non absorbable depending on the choice of the surgery.

Typically a patient after a laparoscopic or an open surgery should be fine to go home after 48hrs. The laparoscopic patient only has a little soreness around the operated area around the groin. However, the open surgery patient has a little longer recovery time because getting in and out of bed is usually difficult. Laparoscopic repairs inguinal hernia, both side hernia is a norm. One sided is also done on certain patients who insist on doing that. Other than that for the umbilical, lumbar and incisional hernias the holes are made at different places and special methods introduced through those pores after reducing the contents and it is also fixed with the help of protax. Recurrences are known in both open as well as in laparoscopic, inguimal or umbilical hernia. It has more to do with the patient factors rather than to do with techniques. Initially it was more with tehniques due to learning but now its more to do with patient factors because its a common norm in these procedures.

That's it for now, if you want to know more about the procedures contact me through librate. Thank you.

Types, symptoms, and treatment for Gallstones

Hi, I’m Dr. Nimesh Shah. I’m a consultant endoscopic, laparoscopic and G.I surgeon. I’m attached to Global Hospital Parel and SL Raheja Fortis Hospital at Mahim, and I’m also a director and partner at Sanjeevani Hospital, which is our hospital at Dadar. We have talked about gallstone disease as of now. Gallstone disease is a very common phenomenon observed in the Indian population. There are various types of gallstones that are available, that is either a pigment stone or a cholesterol stone. Pigment stone occurs because of hereditary spherocytosis or something wrong with your blood cells, which get destroyed more, and that causes gallstones.

The other cause of gallstones is a cholesterol inborn error. The other type of gallstones are cholesterol stones, which are due to inborn errors of metabolism of a cholesterol as either the cholesterol that is secreted by the liver is much more, or the water that is secreted by the liver is less. So the gall bladder which…whose function it is to super-concentrate the bile concentrates much more than what is necessary, and you get crystallites of cholesterol stones formed. These are most common stones seen in the Indian population.

The symptomatology of this is usually bloating, a fullness of abdomen, a lot of flatulence, also some patients have a lot of refluxes, we call it a…which is associated with gallstones hydro semi a. And also some patients develop severe pain which is called as a biliary colic, which may need medical intervention. The diagnostic modality that is used for gallstone disease is doing an ultrasound. An ultrasound will tell us on the thickness of the gallbladder, the type of stones, the multiple stones, or multiple small stones, or a single large stone. So the number of stones, if you have multiple stones, you may develop a biliary colic. If it’s a large stone you may develop acute inflammation of the gallbladder, which will need hospitalization.

The gold standard of treatment is surgery. Surgery is usually done laparoscopically, wherein small holes are made in the tummy and the gallbladder is removed completely. If y=remove your gallbladder, there is no problem in your digestion or anything like that, because effectively, the bile that is secreted by the liver is a waste product of our body, it has no role to play in digestion. It only activates the enzymes of the pancreas when it mixes with the pancreatic juice in the pancreas…in the intestine. The liver secretes about two and a half to three liters of bile every day, out of which 150 to 200 ml goes in the gall bladder. Out of the 200 ml, it is emptied every time you eat. So roughly about 800ml is concentrated by the gall bladder and is emptied into the intestinal...intestinal tract. Now vis-à-vis, 2.5 liters is flowing straight into your intestinal tract. So it does not really hamper your digestion in any way.

Again going back to treatment as laparoscopic surgery is the preferred and gold standard of treatment worldwide, wherein three four small holes are made and the gall bladder is completely extracted. Some patients at some centers are doing the single port, that is a single hole through the umbilicus, which is technically much more difficult. There is always a percentage chance of having to cut open a patient during surgery that may be because of bleeding or abnormal abnormality, which is quite common in the gall bladder region.

The above information is a limited information. If you need to further know about the disease then you can contact me directly through Lybrate.