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Hernia repair with the da Vinci Si surgical system. Picture a football. On the outside, there are leather panels securely stitched together. Inside, there is an airtight sac, and when it is pumped full, air presses outward on the sac. The leather contains the sac, allowing the football to retain its shape. An aging football, though, might start coming apart at the seams. When this happens, it isn't hard to imagine the air sac bulging out of a seam where the stitching is weak and the pressure inside the sac is high.
The same is true for our bodies. We are complex organisms, and our abdominal muscles have a demanding job keeping all of our internal parts in place. Sometimes, these muscles weaken enough that small spaces appear between them. If an organ starts bulging through the space, it's called a hernia.
The highly skilled and well-trained general surgeons at Cedars-Sinai Marina del Rey Hospital evaluate patients with various types of hernias and provide an individualized treatment advice for each patient. They can choose from the various surgical treatment options available. The treatment that works best for your symptoms and severity of a hernia is considered.
Hernia is a medical condition where the internal part of the body pushes through a weak tissue wall or a muscle. Hernia may appear as a lump or swelling in the abdomen or groin, at times, it will be visible only on coughing or straining. Most hernias occur in the abdomen. This lump can be pushed back or will disappear when a person lies down.
Usually, a combination of muscle weakness and excessive straining such as lifting heavy weights might contribute to this disorder. Hernias are common and can affect men, women, and children. Some people are born with weak abdominal muscles and are more likely to develop hernia.
Most hernias do not get better without surgical intervention. The doctor will conduct a thorough examination if necessary through an ultrasound to confirm and assess the extent of a hernia and decide the need for surgery. If the doctor decides surgical treatment, this will involve repair of the opening created in the muscle wall.
Surgical approaches for treatment of hernias include:
Open surgery: In this type of surgery, a large sized incision is made that allows the surgeon to move the lump forcefully back into the abdomen. A supporting mesh may be placed on the wall of the muscle or the tissue wall to provide extra support.
Keyhole (laparoscopic) surgery: This is a minimally invasive surgery and advanced technique in which several smaller cuts are made to enable the surgeon to insert various special instruments to repair a hernia. Most patients may be discharged on the same day or the day after their surgery. A complete recovery may take a few weeks.
The type of treatment is advised based on the size and severity of your symptoms. In some types of hernias, which are small and do not cause any symptoms, your doctor may consider a wait and watch approach. Routine follow-up visits may be scheduled to check whether the size of the hernia is increasing. Trusses, corsets, or binders can be used to hold hernias in place by placing pressure on the skin and abdominal wall. These methods are temporary approaches and may result in skin damages, breakdowns, and infection because of rubbing and chaffing. These are often considered in elderly, debilitated patients with an increased risk associated with surgical treatment, problems with tolerating anesthesia, and when the hernia defect is very large. Some types of hernias in children tend to resolve on their own once the child reaches one year. In some cases, medicines are prescribed to control the symptoms.
Hernias can occur in any part of the body; they commonly develop in the area of your body between your chest and hips. Some of the most common types of hernias are described below:
Other types of hernia include:
Epigastric hernia: This hernia occurs when the fatty tissue pokes through the abdomen, between the navel region and the lower part of the breastbone.
Spigelian hernia: This hernia occurs when a part of the bowel pushes through the side of the abdominal muscle, below the navel region.
Incisional hernia: This hernia occurs when tissue pokes out through a surgical wound inside the abdomen that has not healed completely.
Muscle hernia: This hernia occurs when a part of a muscle pushes through the abdomen. This type of hernia can be seen in leg muscles as the result of a sports injury.
These symptoms are due to lack of blood supply to a portion of the organ or tissue that gets entrapped in a hernia (strangulation) or if there is an obstruction when a part of the bowel enters a hernia. A strangulated hernia and obstructed bowel are considered medical emergencies and need to be treated with high priority.
Your doctor will perform a careful physical examination on the affected area to find a bulge. Generally, you will be asked to stand and cough or strain so that your doctor can feel the bulge caused by a hernia as it comes down to the groin.
Ultrasound of the abdomen: To know the extent of the problem and confirm the diagnosis doctors suggest an ultrasound. In this test, high-frequency sound waves are passed into the region of your body to be evaluated so that an image can be created.
Other imaging tests such as abdominal X-rays and CT scans may be ordered if necessary.
Gender: Males are more likely to develop an inguinal hernia. This type of hernia may sometimes develop in infancy or in adulthood.
Family History: People having a family history of hernias are at high risk of developing a hernia.
Medical Conditions: People with disorders such as cystic fibrosis that affects the lungs may have a long-standing problem of coughing that may lead to hernia.
Age: With advancing age, the muscles and tissues tend to become weak and induce hernia when daily activities are performed.
Straining: Lifting or pushing heavy objects exerts excessive pressure on your body leading to hernia.
Chronic coughing: A long-term cough caused by smoking or other respiratory disorders can induce hernia.
Chronic constipation: Excessive straining during bowel movements may lead to hernia.
Excess body weight: Being obese or overweight will induce a lot of pressure on the muscles of the abdomen and limbs resulting in hernia.
Pregnancy: Pregnancy weakens the abdominal muscles due to increased stress on these muscles, leading to hernia.
Occupation: Occupation that requires standing for long hours or performing heavy physical labor increases your chances of developing hernia.
Premature birth: Infants born before term are more likely to have an inguinal hernia.
Congenital defect: Failure of the abdominal wall to close properly during developmental stages in the womb can lead to the development of hernia after birth.
Injury: Damages resulting from a severe injury or surgical procedure may induce development of hernia.
Hernias are usually caused by a combination of weakened muscle and straining. Based on its cause, hernia may develop quickly or gradually over a long period of time. The causes of muscle weakness include increased age, chronic cough, and damage from any surgical procedure or injury. Straining of these weak muscles during lifting of heavy weights and performing daily activities can cause hernia.
Yoga: Yoga involves deep breathing exercises and gentle stretches that help strengthen and relax your muscles. Yoga can also help in reducing stress.
Medicines: Alternative medicines (Homeopathy, Ayurveda, and Unani) can be used in the treatment of muscle weakness, chronic cough, swelling, constipation, and associated disorders.
Acupuncture: This treatment may assist in strengthening the area associated with hernia.
Acupressure: Acupressure can control the symptoms of a hernia like gastric reflux, relieve stomach and digestive discomfort and feelings of fullness in the chest. Acupressure can relieve pain and improve blood circulation.
Massage therapy: Gentle massage around the affected area by an expert, followed by strengthening of the muscles can cure hernia.
Here are some preventive measures that can be followed to reduce the risk of developing hernias:
Lifestyle modifications: Follow a regular exercise routine to maintain fitness, strengthen muscles, and maintain a healthy body weight. Avoid exercising soon after eating, and wait for at least two to three hours before you perform exercises. Avoid smoking and consumption of large amounts of alcohol.
Food habits: Always maintain a healthy diet. Avoid eating unhealthy food and over eating. Reduce the intake of food and beverages containing excess caffeine.
Avoid rapid weight loss: Rapid weight loss programs usually reduce the protein intake thereby result in further weakening of the muscles.
Avoid lifting heavy weights: Avoid lifting heavy objects and use the proper lifting technique, which involves using your knees to move them.
Clothing: Wearing loose and comfortable clothing that does not exert pressure around your abdomen.
Do you think you have symptoms of hernia? For any questions, information or guidance related to hernia, consult our specialty-trained, skilled general surgeons at Cedars-Sinai Marina del Rey Hospital.
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