Category

Hernia

Category

Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. Hernias have a high rate of recurrence, and surgeons often use surgical mesh to strengthen the hernia repair and reduce the rate of recurrence. The use of surgical mesh may also improve patient outcomes through decreased operative time and minimized recovery time. Now let’s understand more about Hernia mesh.

What is hernia mesh?

A hernia mesh is a surgical device used to provide added backing to damaged or impaired tissue due to hernia till it gets healed. It is placed through the area around the hernia, attaching it with stitches, staples or glue. Mesh’s pores let tissue to grow into the device.

How a hernia mesh works?

A hernia surgical mesh functions as an elastic scaffold for hernia repair. It reinforces walls of muscles and prevents organs from protruding through them.

Types of Hernia mesh

Most of contemporarily existing hernia mesh devices are composed of synthetic materials or tissues of animals. Surgical mesh manufactured from synthetic materials is available in knitted or non-knitted variants. The synthetic hernia meshes are made of absorbable, non-absorbable or a combination of these materials. Animal-derived meshes are made of processed and disinfected intestine or skin of pigs or cows, which are absorbable, suited for application as an implanted device.

Is Hernia mesh safe?

Hernia repair using mesh is currently one of the most regularly accomplished surgeries in general surgery. The use of mesh is recognized to reduce recurrence rates of hernia. As per evidence, non-mesh repair of hernias are associated with a higher recurrence rate at 1 year when compared to mesh repair.

Currently, chronic pain following hernia surgery is the most concerning post-operative complication with recurrence rates decreasing than ever before by using surgical hernia mesh.

Hence, the focus in hernia surgery is now shifted in defining, assessing and identifying risk factors relating to chronic pain. Chronic pain hernia surgery is a vital problem for a considerable number of patients. Some identified risk factors for post-operative pain include younger age, female gender, hernia recurrence, operative complications, and elevated pain levels in the immediate post-operative period. However, recent evidence confirms the safety and effectiveness of mesh utilization in hernia surgery. The recent evidence demonstrates that hernia repair with mesh is not linked to an intolerable level of severe chronic pain. Complication rates are low for hernia repair surgery and in majority of cases, not related to the mesh itself. It is shown that pain scores normally improve post 1 year of hernia repair.

How long does Hernia mesh last?

Non-absorbable mesh stay in the body forever and is termed as an everlasting implant. It is used to provide long-lasting support to the repaired hernia. On the contrary, absorbable mesh gets degraded eventually, losing its strength over time depending on its composition. It is not meant to provide lasting support to the repair site. As the absorbable mesh material degrades, new tissue growth is meant to give power to the repair.

If you are unsure about the specific which mesh to go with, mesh manufacturer and brand used in your surgery and have questions about your hernia repair, contact your surgeon or the facility where your surgery was performed to obtain the information from your medical record. 

If you get a minor cut or scrape at home while chopping food or while playing then it usually is self-treatable through the use of bandages or any home remedy. But, what if you get a nasty cut then how will you comprehend in case of a suture or a staple requirement? Usually, severe gash or wounds require the use of sutures, staples or surgical glues in order to close the wounds or surgical incisions. Doctors choose appropriate methods depending on the type of the wound or the surgery required.

Having said that, both sutures and staples have peculiar benefits and limitations that make them more or less appropriate for specific conditions. In many cases, sutures are essential for convenient healing. Severe wounds and deep cuts are prone to infection and other complications, and the longer a wound stays naked and vulnerable, the greater the risk of infection becomes. Sutures are one of the most common methods used for closing wounds of the skin. However, in cases of major wounds, the selection of an optimum method of wound closure is extremely vital. The type of material and technique depends on many factors such as depth, appearance, size, location, bleeding, age, material availability, and your doctor’s preference. 

Sutures

This is the most common method used for closing skin wounds. Sutures are basically thread-like medical devices that can either be permanent or temporary in nature, depending on their material of the composition.

Your doctor uses a surgical thread to sew or stitch two ends of the skin together. Temporary sutures get degraded in the body. However, the suture type to be used is decided by your surgeon based on your medical history. Your doctor may prefer to use permanent sutures in case you have:

  1. A major wound that might take a prolonged period to heal.
  2. To close your surgical wounds.
  3. Tying off blood vessels or bowel parts.
  4. If your wounds involve connective tissues or muscles.

Biodegradable sutures are preferred in cases of lower skin layer wounds, internal mouth surface wounds, internal soft tissue or smooth muscle wounds. Wounds with vasculature close to the skin surface are also preferred to be stitched by biodegradable sutures.

Sutures must be removed within 1-2 weeks of their placement, depending on the intensity and location of the wound. Immediate removal reduces the risk of marks, infection, and tissue reaction.

Staples:

Doctors prefer to use a surgical stapler in case of a long skin wound or an incision in a difficult-to-reach area. Alike sutures, staples can also be permanent or dissolvable in nature. Permanent staples need to be removed by your doctor. However, with dissolvable staples you have a lower risk of getting infected.

There are a plethora of benefits associated with the use of staples:

  1. They permit rapid wound closure causing the lowest damage.
  2. They are easier to apply and remove as compared to sutures, and anesthesia is given for a much lesser time.
  3. The most vital advantage of using staples is a decreased infection risk.
  4. Wounds also heal better with staples and lower are the chances of scar formation.

Surgical staples need to stay in for some days or up to 21 days in some cases before they can be removed.  How long the staples must stay in place depends mostly on factors such as:

  • Size and placement of the incision.
  • The type of surgical procedure. 
  • The complexity or severity of your incision or wound.

Numerous signs that your surgical staples may be ready to be extracted include:

  • The area has recovered completely and the wound won’t reopen.
  • There’s no pus, fluid, or blood drainage from the area.
  • There aren’t any symptoms of infection.

It is evenly important to take post-care of your injury or wound, once the stitches or staples are removed. Check with your doctor on how to take the necessary precautions which will help restore and heal your scars.

Despite the fact that they differ in many ways, sutures and staples are cosmetically equal when it comes to scarring. Conclusively, a doctor will decide the choice of technique and device based on his or her experiences and preferences according to the case.

A hernia repair surgery is usually very safe but several risk factors determine patient’s morbidity and mortality. Incarceration and strangulation are some of the common complications of hernias. The surgery complications include infections, fascial dehiscence, recurrence, visceral injury, and mesh erosion preset by many risk factors.

Strangulation and Incarceration:

A strangulated hernia occurs when the blood supply to the affected tissue has been cut off. This situation forces to release toxins and infection into the bloodstream, which could lead to sepsis or death in some cases. An incarcerated hernia occurs when herniated tissue becomes trapped and cannot easily be moved back into place. This state can lead to bowel obstruction.

Surgical complication:

As compared to laparoscopic surgery, an open approach has higher chances of complications. Most of the serious complications occur while accessing the abdominal cavity. Most common injuries occur to the small bowel and the iliac artery. Patients with past abdominal injuries or abdominal surgeries are more prone to severe complications.

As per the available evidence, surgical repair is the only current effective way to treat a hernia and it could be of two types – conventional and non-invasive. Hernia surgery can assist relieve pain, return the hernia abdominal organs to their exact place thus reinforcing the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It is a routine procedure, but as with all surgeries, there are risks of complications.

The conventional procedure being the open procedure whereas the non-invasive method includes laparoscopy. Though the hernia surgery is termed as “safe”, however, all surgical procedures come with certain risks. Probable risks involved in a hernia surgery could be:

  • Wound Infection at the cut- Despite the latest technologies and advancement in the surgical procedure, post-operative infection is still the leading cause of complications in hernia surgery. Infections can occur due to various reason including sutures, mesh that fails to suit the human body.
  • Recurrence of hernia- This state is occurred due to deep infection or when there’s extra pressure on repaired site or when a person resumes to physical activities much earlier than suggested by the doctor. However, it is preventable by mesh implantation.
  • Post-operative risk- This occurs as a direct result of fascial tissue failure to heal post laparotomy. Factors that can add to the misery is excessive smoking, obesity, age, malnutrition etc.
  • Blood clot formation due to prolonged bed rest.
  • In some cases, an open hernia procedure may lead to nerve damage and the patient can develop chronic pain in the affected area post-surgery.

The recovery process may depend on the surgical procedure itself. Majority of patients undergoing open hernia surgery can return home the same day and the estimated recovery time frame is proximately 3 weeks to 1 month. Depending upon your nature of work, total recovery may require one to six weeks. In the case of laparoscopic hernia surgery, the patient can return home the same day and estimated recovery period is about 1 to 2 weeks. One must wait for a month before starting any heavy exercises or activities that may cause strain.

Usually, the faster you return to your regular lifestyle, the better is the recovery rate. However, consult your surgeon before making any assumptions yourself because a prolonged approach can also lead to several complications. Your doctor may suggest that you wear a corset or a truss to lessen the pain. These supportive undergarments apply gentle pressure on the hernia and hold it in place. They may relieve any kind of discomfort or pain and are used only for temporary relief.

Among surgeries, a laparoscopic procedure is preferred because it shortens the duration of recovery post-surgery. However, a hernia recurrence post-surgery is not uncommon. A recurring hernia can be identified as a lump, occasionally painful, appearing at or near the site of the initial hernia. If the recurrence is progressive, it can lead to major complications.

There could be various reasons adding to the factor such as infected hernia wound, resuming heavy physical activities soon after surgery, chronic cough, and obesity. Other common predisposing factors are smoking, old age, and muscle weakness. Hence, it’s always advisable to practice a certain healthy lifestyle which includes maintaining a healthy body weight, avoid lifting heavy objects without supervision and eating a fiber-rich diet to make bowel movements softer and easier to pass

Hernias are rather usual and can confound anyone. However, how can you know that you have developed one? There are various causes of hernia such as straining of muscles due to heavy weight lifting, multiple pregnancies, congenital reasons or you can get one even from a recent accident. Additionally, lifestyle variables such as obesity, smoking, and not having a nutritious diet can cause a hernia.

The abdomen is the most common area for developing a hernia, however, it can also be seen in the upper thigh or chest. A hernia can take time to show symptoms and sometimes those symptoms can lead to intense pain thus leading to surgery. The conventional symptom of a hernia is the appearance of a bulge in the groin area. You may observe a lump in the pubic region if you have an inguinal hernia whereas hiatal hernia has more characteristic symptoms such as heartburn, chest pain, breathing, and swallowing problems etc. In many cases, a person may not complain of any symptom at all and it may be accidentally detected during a routine examination. As your hernia grows, discomfort may grow as well.

Early signs of a hernia may include:

  • A bulge in the groin area or scrotum or swelling in the scrotum.
  • Pain or discomfort in the affected area which worsens during bending or heavy lifting.
  • Heaviness in the abdomen and burning or aching sensation in the bulge.
  • Pain or aching sensation while passing stools or urinating.
  • Pain in the abdomen, typically during evenings after you have remained standing for most of your day.
  • In case of a strangulated hernia, you may also have a fever, vomiting, nausea, and severe abdominal cramps.

While a hernia may begin as an innocuous lump, it can get bigger and begin to trouble with time. In some cases, it can even be perilous. So regardless of whether it doesn’t appear to be a serious deal, it’s ideal to see your primary care physician in case you have indications of a hernia, similar to a bump or lump you can’t clarify.

Seek medical attention immediately if you have a hernia and these symptoms:

  • The bulge appears to be dark, purple, or red.
  • You can’t pass stools.
  • You have a high fever.
  • The pain quickly worsens.
  • You’re throwing up or have an upset stomach.

The diagnosis of a hernia is generally a clinical one, which implies that your doctor will go through a history of your symptoms followed by a brief physical examination. In the great majority of cases, where there is a conspicuous swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and no tests are needed. More challenging diagnoses are best performed by hernia specialists.

Usually, your doctor can determine if you have a hernia with just physical examination. They may ask you a variety of questions along with cross-checking your medical history. During this diagnosis of a hernia, your doctor may ask you to perform activities like standing and coughing to confirm the possibility of a hernia.

Furthermore, your doctor will confirm that you have a hernia by prescribing some tests such as ultrasound of your abdomen, A CT or MRI scan which is like X-rays. Your doctor may also ask you to undergo an endoscopy; a non-surgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a colour TV monitor.

For adults, particularly if the medical procedure could be dangerous for you, your primary care physician may propose simply watching out for it as long as the hernia’s small and not creating any serious issues for you. However, in some cases, you can always lower your odds of getting a hernia by following simple steps such as following a well-balanced diet and staying at a healthy weight, quitting smoking, talking to your doctor if your cough won’t go away, and using the correct form while doing any physical activity (bend from your knees instead of the waist while weight lifting).

If you think getting your surgery done is the last piece of the puzzle then you may be wrong because you might still have to show some resilience till the time your stitches or sutures don’t come off or are dissolved as instructed by your surgeon. Though getting done with the surgery covers the majority of the procedure, adequate post-operative care of your stitches or sutures is still an important aspect that needs to be managed well to avoid any future problems. Before moving on to the post-operative management of the wound, let us first understand more about sutures or stitching.

Sutures and stitches are used for the same purpose – to close wounds or surgical incisions. For sutures, doctors use a thread or strand of material to perform wound closure. The term ‘stitches’ refers to the surgical procedure of closing a wound with the help of sutures. There are basically two types of sutures, absorbable and non-absorbable. Absorbable sutures don’t require your doctor to remove them, while the Non-absorbable sutures will have to be removed at some point in time by your doctor. The kind of material to be used for sutures will completely depend on your doctor’s observation and analysis of the wound and the material type that’s appropriate for the wound or procedure. From piles to bariatric surgery to a hernia repair surgery, suturing is a part of most of the surgeries with incisional cuts and has to be performed with utmost precision and accuracy. Sutures are used for maintaining tissue contact until optimal healing is achieved to provide internal wound strength. When it comes to hernias, the selection of suture and suturing technique is based on the type of underlying hernia, its dimensions and the operative technique used for a hernia repair.

Though there’s no clear evidence that says one particular type of suture is better than others, it is important to care for your sutures irrespective of the material type so that it helps the healing process. Any negligence can slow down the recovery process and cause a lot of pain to the patients.

Below are some of the common symptoms that indicate that your wound has split or is damaged.

  • Inflammation
  • Bleeding from the wound
  • Broken suture
  • Pain near the wounded site
  • Swelling
  • Fever
  • Puss formation

Open wounds often require immediate attention and doctors usually opt for antibiotics or debridement (removal of dead tissue from the wound). It is always advisable to get in touch with your doctor in case any such symptoms are observed. Classically, your sutures require to stay in play for some days to even 1-2 weeks, as per the severity of the incision and its location. Usually, as your sutured wound starts to heal, your doctor will instruct you to take proper care of your sutures, which includes cleaning, dressing and drying your wound.

How to care for your sutures/stitches

Moisturise: Applying moisturizing creams with high Vitamin and Aloe vera content can help the wound’s faster recovery

Massage: Massaging the wound gently over time can help in reducing the scar and also increases the blood flow near the wound which can help in faster recovery. However, the pressure applied should be moderate and should not initiate any pain or discomfort near the operated area.

Avoid activities that expose the wound:It is advisable to avoid exposing the wound to any physical activity that adds pressure on the wound or makes it dirty, increasing the chances of an infection.

During the removal of your stitches, your doctor will analyze, observe the state of your wound and then only give a go-ahead. Removing sutures is a much quicker procedure than applying one. You might simply experience a minor pulling sensation and some pain which is due to your body trying to guard itself against organisms trying to enter inside through the cut. As a protective mechanism, the body releases chemicals for aiding your WBCs to fight against infections. As a result of this mechanism, you will feel pain and inflammation due to your nerve stimulation in the area.

If the pain is intense and you are not able to tolerate it, you can take paracetamol as a pain-killer. Avoid take aspirin, ibuprofen or any NSAID to relieve pain, as they may make it difficult for your blood to clot during wound healing. Or else, you may place an ice pack to decrease your pain and inflammation at the affected area for 15 to 20 minutes every hour. This procedure can also reduce bruising. Also, remember that removing stitches on your own is not a good idea. When doctors remove stitches, they look for multiple signs such as infection, state of healing, and wound closure. But when you try to do it on your own, you skip this final observation step which could be lethal for you in the coming future.