Surgical Gastroenterology is a full-fledged department with laparoscopic surgical facilities. The department deals with all diseases connected with the entire digestive tract, besides Liver, Gall Bladder, and the Pancreas. The department is keeping pace with the current trends worldwide in the diagnosis and treatment of all surgical problems related to the digestive tract. The services offered by the department include
- Photo Coagulation Therapy
- Laser Coagulation Therapy
- Drainage of pancreatic pseudo cyst H.S.V. & G.J.
- Surgery for Oesophageal Stricture
- Surgery for Hydatid disease
- Surgery for Achalasia cardia
- Surgery for various liver cysts
- Surgery for Hiatus Hernia
- Total gastrectomy with Roux-En-Y Loop
- Radical resections for cancer of the Bowel
- Pouch surgery for inflammatory bowel disease
- Management of intestinal fistulae
Laparoscopic repair of hernia
Hernia is any weakness of the abdominal wall leading to the protrusion of bowel. There are several types of hernia depending upon site, cause etc. The repair of these defects can range from simple placements of sutures (to approximate the defect), to plastic surgeries involving rotation of adjacent tissues in cases of complex post operative hernia. Thankfully the large majority can be repaired by either simple approximation or more commonly the placement of synthetic mesh.
Small defects can be closed with sutures. Large defects need bridging materials, as suturing under tension invariably leads to sutures cutting through and eventual recurrence of the hernia.
Some of the common hernias are
Inguinal hernia: common in men. These are noticed as a lump which appears on coughing or straining. Initially it tends to reduce, however as it enlarges it becomes irreducible. Bowel often prolapses through the hernia and there is a risk of bowel strangulation as the condition advances.
Umbilical hernia: Common in neonates especially premature babies. Often tends to close spontaneously. Adults also get umbilical hernia (more correctly called paraumbilical hernia). In adults, occasionally these can be due to secondary causes, such as ascites, obstructive airway disease etc.
Femoral hernia- Common in women, occurs medial to the femoral vessels, can be difficult to diagnose.
Incisional hernia – following surgery.
There are other special herniae such as internal herniation due congenital defects intrabdominally.
|Figure 1 Strangulated inguial hernia containing bowel|
Do all herniae need repair?
The main reason for hernia repair is the ever present risk of strangulation of the contained bowel. The risk is low but unpredictable. Certain hernia are at high risk of causing strangulation and repair is advised early. Examples are femoral and recurrent inguinal hernia. In both these, the defect edges tend to be narrow and rigid and hence pose a higher hazard of strangulating the bowel.
What are the surgical options?
Most inguinal hernia tend to be repaired with mesh. Laparoscopic repair of inguinal hernia can be achieved through smaller incisions. It is a good option for bilateral hernia, as both sides can be repaired through only three small incisions all no more than a centimeter in length. Laparoscopic hernia repair is also a good option for recurrent hernia, as the surgery is done from inside and hence avoids opening up the previous scar tissue.
We offer laparoscopic hernia repair for our patients.
These can happen after any abdominal operation. Repairs can still be followed by recurrence. Open repair involves opening up the entire scar and hence often is as painful as the primary repair. These can be repaired laparoscopically. However special meshes are required. These have a dual layer, the visceral layer uses special collagen based material so that bowel damage does not occur (as happens with conventional prolene meshes, when laid in direct contact with bowel). These meshes due to the nature of the technology involved tend to be expensive. However the increased cost is to some extent mitigated by reduced hospital stay due to lesser pain and earlier recovery.
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