Kaizen Hernia Center

Protrusion or bulging in groins which increases more on coughing ,crying, straining can be inguinal hernia. More commonly found in smokers, patients with asthma or lung disease chronic constipation or with history of operations such as prostatectomy or appendectomy. all symptomatic patients require surgery to prevent complications such as incarceration or strangulation of bowel which can lead to mortality. The lax abdominal wall is strengthened with help of prolene mesh which is inserted by Open or Laproscopic method. Patient is usually discharged on same or next day and can resume work early. Now a days the operation commonly performed by Laparoscopic method with better result and less pain.

It is protrusion or bulge present at umbilicus due to defect in umbilical scar. It is seen in both children and adults. In adults it is mostly due to extreme obesity, prolonged labour or large intra abdominal mass. It is more common in women. It presents with bulge at umbilicus with straining along with dull dragging pain. If bowel is entrapped it presents with distension of abdomen and vomiting. Immediate repair after diagnosis should be the rule for the fear of strangulation of bowel as neck is narrow.infants can be managed non operatively with observation as defects usually close spontaneously up to 4 years of age if defect is less than 2 cm in diameter. In adults it is closed with or without mesh. Laparoscopic techniques with mesh placementhas been quite effective with low recurrence.

It is the protrusion of organ or tissue through abdominal wall that has been weakened due to previous surgery. The balloon like sac may trap intestine or other abdominal content which could cause potentially serious problems requiring emergency surgery. Patient notices bulge at site of scar of previous operation or adjacent to it. Associated risk factor such as wound infection, emergency procedure, obesity are usually noticed in history. Diagnosis is usually clinical and very small hernia presenting with pain without prominent bulge in obese patients may require ultrasound and CT Scan for confirmed diagnosis. Surgery is the main modality of treatment with either open or laparoscopic approach and placing large prosthetic mesh to strengthen the abdominal wall. Patient has shorter hospital stay with laparoscopic approach and can resume duties faster. Obese and malnourished patients face higher chances of recurrence and wound infection.

A parastomal hernia is a type of incisional hernia that allows protrusion of abdominal contents through the abdominal wall defect created during ostomy formation

Risks Factors

Patient factors

• Age
• Obesity
• Intra – abdominal pressure factors
• Emphysema

Wound healing factors

• Infection
• Steroids
• Genetics (collagen deficiency)

Surgical Technique

• Site outside of rectus sheath
• Too large stoma defect

Symptoms

• Pain
• Prolapse of stoma
• Protrusion of stoma beyond abdominal wall
• Appliance leakage/poor fit
• Enlargement of stoma
• Strangulation

Management

• Onlay mesh repair
• Inlay/Interposition
• Sublay/Underlay
• Sugarbaker
• Keyhole / Laparoscopic surgery