A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias can be congenital or acquired. Due to the location, we can distinguish:
- inguinal hernias
- scrotal hernias
- femoral hernias
- epigastric hernias
- umbilical hernias
- postoperative hernias
- recurrent hernias
- hiatal hernias.
It should be remembered that regardless the type of hernia, surgery is the only effective method of treatment. Once a hernia is formed, it will not disappear spontaneously. The delay in diagnosis of hernia may lead to its incarceration. An incarcerated hernia occurs when herniated tissue becomes trapped and cannot easily be moved back into place. Hernia incarceration is an acute condition that may lead to a bowel obstruction or strangulation.
How is a hernia treated?
Hernia repair may be performed as on open or laparoscopic surgery. The decision about the operating method is made by surgeon based on size and location of the hernia, patient’s surgical history and comorbidities.
HIATAL HERNIA REPAIR
A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This results in gastroesophageal reflux disease. Patients most commonly complain of epigastric pain, heartburn, chest pain, cough and dyspnea.
A Nissen fundoplication is a surgical procedure to treat GERD and hiatal hernia and is usually performed as a laparoscopic surgery. Primary, the pneumoperitoneum is formed and the surgeon makes few small incision to place the trocars for camera and surgical instruments. In the first stage of Nissen fundoplication, the hernia sac is removed from the chest to abdominal cavity. The abdominal esophagus and crura of diaphragm are released. The esophageal hiatus is narrowed by sutures to prevent the concurrent hiatal hernia. Finally the fundoplication is performed and the gastric fundus is wrapped around the lower end of the esophagus and stitched in place.