Hernias in the COVID Era

Hernias in the Covid Era

Not all abdominal hernias require surgery and this is particularly true during the Covid lockdown. However, hernias causing pain or intestinal upset can and should be surgically repaired even during the Covid lockdown. During times like these, necessary, urgent, or emergent surgery CAN be performed safely. It is important to avoid delays in medical and surgical treatment. Delays in surgical treatment can result in a worsening of medical and surgical conditions.

An overview of hernia can enhance one’s understanding of it helping in making a decision when to see a doctor and when to go for elective or emergency surgery.

Hernia: Etiology, Diagnosis & Treatment

A hernia is a protrusion of an organ through the wall of the cavity containing it. 

It can appear as a bulge in the abdomen or groin region. 

A defect in the muscular wall holding abdominal contents in place results in an opening or a weak spot in the wall allowing displacement of abdominal fat or intestine.

Etiology

A hernia may develop due to congenital abnormalities or anatomical variations. Physiological conditions and diseases that increase intra-abdominal pressure can further aggravate the underlying problem. These include:

• Persistent cough
• Smoking
• Obesity
• Straining while urinating or defecating, e.g., in constipation
• Heavy weight lifting
• Enlarged prostate
• Abdominal fluid

Types of Hernia & Associated Risk Factors

The following table summarizes types of hernia along with their location, features, and risk factors.

Type of Hernia	Location	Features &Risk Factors
1.Inguinal hernia (Most common)	Groin	MaleOlder adultsSmokersConstipation  patientsPrevious history of hernia
2.Umbilical hernia	At the navel	Babies with premature birth or low birth weights
3.Femoral hernia	Just below the groin	Female>MaleCauses strangulations
4.Hiatal hernia	Upperpart of stomach	Over weightAge over 50
5.Incisional hernia	At the site of a previous surgical incision	Recent  surgeryWeight gain after surgery

Sign & Symptoms

Hernia often presents as a palpable lump under the skin that may or may not be associated with pain.

Sign & symptoms vary with each type of hernia.

A reducible hernia is a hernia that can be pushed back into the abdomen. It can become more prominent with any activity increasing the intra-abdominal pressure, e.g., standing, heavy weight lifting or straining.

However, a non-reducible hernia doesn’t show any variation in size. It is a more chronic form which can lead to strangulation of blood vessels and kinking of the intestine. Nausea, vomiting, and other abdominal symptoms may appear as a result of obstruction.

Treatment

An asymptomatic hernia requires a more conservative approach.

 It includes dietary modifications, changes in lifestyle, exercise, quitting smoking, and some medications. Your doctor may recommend watchful waiting.

A truss is sometimes advised especially for inguinal hernia. It is a belt-like device that aids in the reduction of protruded content.

Surgical treatment for hernia depends on the type of hernia & circumstances and done mainly to prevent complications.

Open surgery repairs the hernia using a big incision pushing herniated tissue back and securing to its original positions often using a mesh to prevent recurrence. 

 This procedure can be performed under local andspinal anesthesia thus avoiding general anesthesia. So it is particularlyadvised to medically compromised patients.

Laparoscopic surgery, is a minimally invasive surgical technique. It uses smaller (keyhole) incisions that allow entry to thin camera and surgical instruments. This technique demands special surgical skills. There are higher chances of recurrence of hernia if an inexperienced laparoscopic surgeon performs the repair.

Laparoscopic surgery has several advantages over open surgery.

It includes;

• Reduced time of hospital stay
• Less chances of infection
• Aesthetics
• Quick recovery
• Fewer complications
• Less chances of bleeding

Robotic Laparoscopic Surgery is the most contemporary technique used for hernia repair. It utilizes keyhole incisions and insertion instruments similar to conventional laparoscopic techniques. Robotic arms are attached to instruments. A surgeon, sitting on the operating console, directly controls the robotic arms. The operating console is equipped with various tools but mainly master controllers and stereo vision.

This state of the art technology further adds the following advantages to laparoscopy.

• Comfortable sitting posture of the surgeon-less likely to be tired
• Full range of motion of robotic arms-a limitation of a human arm
• Elimination of physiological tremors
• Superior cross infection control protocol-less chances of infection

Why Choose Us?

Surgery Group LA (Los Angeles) is a team of highly skilled board-certified surgeons with vast experience in robotic laparoscopic, conventional laparoscopic and open hernia repair surgeries.

 Conservative management and avoidance of surgery is the desired treatment in these patients. This exactly matches our mission statement.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’scondition so you can make an informed decision.