The Surgical Home Page

These pages are to help you regarding your surgical condition. It has been recognized that prior knowledge of what might happen before, during and after a surgical procedure allays anxiety and speeds recovery.

Contents Review of VVs

 HERNIAS

 VARICOSE VEINS

GALL BLADDER

HERNIAS

If you have or think you have a hernia, you are not alone. Over 1.2 million hernias are treated world-wide every year. One in every eight men will get a hernia at some time in his life. Most hernias can be successfully treated. And you probably won't have to take a lot of time off work. With a technique called laparoscopic hernia repair, you can probably get your hernia repaired and return to limited activity in a day or two and return to full activity in one to two weeks. And you should be able to return to work within five days of treatment.

 


What is a hernia?

A hernia is the protrusion of an organ or part of an organ through the wall of tissue that normally contains it.

Your internal organs are held in place by your abdominal wall. A weak spot in the muscle may allow tissue to poke through. The tissue that pokes through is the hernia. It looks like an inner-tube protruding through a tire and, not surprisingly, it is called a "hernia sac".

Hernias can cause discomfort, including a burning or tingling in the groin or pain when coughing, straining or passing urine. People with mild hernias can function for years without treatment, although their ability to engage in physical activity will be limited. However, once you have a hernia it will not go away without treatment.


Is there more than one kind of hernia?

There are many different kinds of hernias. They are usually named after their location in the body and they usually occur in a place that is naturally weak.

Inguinal hernia -- Inguinal hernias are the most common and usually affect men. This type of hernia is located in the groin area, below the navel and above the thigh. Inguinal hernias occur at the juncture of the abdominal wall and the inguinal canal. Prior to birth, the testes descend from the abdominal cavity via the inguinal canal into the scrotum. A hernia occurs when this natural opening in the muscle layers allows a hernia to form or a weakness in the nearby muscles creates an opening for a hernia formation.

Femoral Hernia - Femoral hernias also occur in the groin, slightly below the inguinal ligament, high up in the thigh. Tissue that pushes through a weakness in the muscle wall at this location is called a femoral hernia.

Umbilical Hernia - Umbilical hernias occur right around your navel and are typically caused by a weakness at the site of the umbilical cord.

Incisional hernia - Sometimes the muscle near the site of a previous surgical incision can become weak, allowing a hernia to form at that site.

 


What causes a hernia?

Hernias usually occur in areas of muscle that are naturally weaker -- usually because some perfectly normal human plumbing already passes through an opening in the muscle.

Since there's already a hole in the muscle wall, straining that muscle can sometimes tear or stretch an opening just enough so that something else (such as intestines) protrudes through it.

Activities that can contribute to a hernia include abruptly lifting heavy objects, severe coughing, child birth, straining during a bowel movement, and/or the natural aging process. These and other stressful activities can stretch the muscle wall, making it weak enough for other tissue to poke through.

Hernias may also be due to obesity and congenital conditions.

 


What are the symptoms of a hernia?

Hernias produce a variety of different symptoms such as:

 

 

 

 

 

 


How are hernias repaired?

Laparoscopic hernia repair will allow most hernia sufferers to resume even strenuous physical activity in a matter of days.

Using laparoscopy, three tiny incisions, about the size of dime, provide the surgeon sufficient access to reduce the hernia sac back through its hole and secure a mesh patch over the weak place in the muscle wall. The incisions are so small they can be covered by a couple of adhesive strips. There is minimal or no scarring. Over time scar tissue forms around the reinforcing mesh, creating a supporting wall that will help to prevent future hernias.

 

Principles of Mesh repair

There are several advantages of laparoscopic hernia repair. Since it is minimally invasive and does not cut into sensitive muscle tissues in the groin, it causes less discomfort. Recovery is speedy; most patients can resume even strenuous physical activity in less than a week. It is common for patients who have had laparoscopic hernia repair to be jogging or playing golf or tennis within few days after the surgery. Patients can typically return to work within a week. And because the technique strengthens the abdominal wall, clinical studies have demonstrated a very low rate of recurrence.

The other main option for hernia repair is open surgery. In open surgery, the surgeon makes a three to four inch incision in the abdominal wall, pushes the hernial sac inside and either stitches together the muscles surrounding the hernia or uses mesh to reinforce the abdominal wall.

The open-incision technique can often be performed without a general anesthetic (i.e. under local anesthesia) and uses conventional instruments. However, the large incision, numerous stitches and the pulling of the muscles causes more discomfort, requiring the patient to take pain medication for several days after the procedure. Even light physical activity, such as walking or climbing stairs can be a major challenge during this period. Normal physical activity cannot be resumed for as long as a month. And the time missed from work can create a serious financial burden for the patient.

The Mesh in place in an open repair

 

 


Timing and Preparation For Hernia Repair Surgery


Unless it is treated, an incarcerated organ can become gangrenous, progressing to perforation and infection. If this occurs, complications are more grave and outcomes less predictable.
Two facts are undeniable:
1) your hernia will never heal itself, and
2) the longer it remains and the larger it becomes, the greater the chance of testicular problems when it is finally repaired.

Unless it becomes an emergency, most hernias can be repaired on an elective basis. Depending on its size, position and reducibility it may be considered a priority.
Shortly before surgery you need to have a few standard blood and urine tests, electrocardiogram and chest x-ray. Your personal physician can provide a note of medical clearance and any pertinent suggestions regarding your care.

 


 

Recovery Following Hernia Surgery


Postoperative discomfort following surgery will vary depending on the size of your hernia, type of repair and your individual level of tolerance. Half of our patients report they required no pain medication whatsoever. The remainder took TylenolŪ or AdvilŪ for pain.
Activities can be resumed without restriction. You are encouraged to "listen to your own body," and to react accordingly. It is literally impossible to harm the repair through any normal activity you do following your surgery. The repairs we perform are immediately stronger than any force you can generate. Patients are re-checked annually to confirm the status of their repairs.

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VARICOSE VEINS

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GALL BLADDER

About Gall Bladder Disease

Gall bladder disease is a common ailment affecting an estimated 20 million Americans. Although gall bladder disease is most often found in women, men may have this condition as well. It is more likely to develop in people who are over forty years of age and those who are overweight.

Symptoms of gall bladder disease range from abdominal discomfort to intense abdominal pain, particularly after eating.

The most common gall bladder ailment is the presence of gallstones. Left untreated, gallstones can lead to serious conditions, including blockage of the bile duct, inflammation of the gall bladder, or bacterial infection of the gall bladder.

These conditions can be painful, but they can be successfully treated by surgically removing the gall bladder. Over 600,000 people in the US had their gall bladders removed last year. Most of these people were treated by an advanced procedure called laparoscopic cholecystectomy, which uses small incisions and offers quick recovery time when compared to conventional surgical techniques.

This WWW site provides information about gall bladder disease -- its causes, symptoms, treatment options, and the names of doctors in your area who may be able to help you. If you think you may have gall bladder problems, you should contact your physician or one of the experienced physicians listed at this site. Only a licensed physician can diagnose or treat gall bladder disease.


What is a gall bladder?

Your gall bladder is a pear-shaped sac, normally about the size of a small pear. It is located on the underside of your liver. The gall bladder serves as a reservoir for a substance called bile. Bile is produced by the liver to help your body digest fatty foods, and is stored in the gall bladder. During and after a meal, when your body begins to digest food, your gall bladder contracts to release bile, which travels through the bile duct to your intestines.

This picture shows the location of the Gall-Bladder


What causes gall bladder disease?

In some people, there is too much calcium and cholesterol in the bile. This causes the formation of small stones (the size of a pea or larger) called gall stones. The gall stones themselves are not harmful, but if one of them clogs the bile duct, the bile can become trapped in the gall bladder causing it to become inflammed.

The liver continues to make bile and sends it to the gall bladder, which will contract and try to release the bile. Since the bile duct is blocked, this contraction can be extremely painful, and may lead to inflammation and/or infection.

Gall bladder disease is the most prevalent in women, although men often have this condition as well. Heredity does play a role in determining who will suffer from gall bladder problems. However, such things as diet, obesity and age are important factors which contribute to the onset of this disease.


What are the symptoms of gall bladder disease?

The symptoms of gall bladder disease vary widely. Some people have gall stones for years without any symptoms at all. The most common symptoms are discomfort or pain after eating, particularly if the meal is rich in fats. These symptoms can range from mild discomfort or indigestion to intense abdominal pain.

Symptoms of more serious or advanced gall bladder disease can include jaundice, nausea, fever, and rapid heartbeat.

If you experience any of the symptoms mentioned above, you should contact your physician or one of the experienced physicians listed at this site for an examination.


What can I do about gall bladder disease?

The first thing to do is see a doctor. A physical exam, a complete medical history, and thorough testing will tell you what is causing your problem. Then, your doctor can tell you what treatment, or combination of treatments, is best for you.

 


What treatments are available for gall bladder disease?

Virtually all gall bladder disease can be successfully treated. Available treatments include a change of diet, medication, ultrasound treatments, or surgery. Non-surgical treatments have limited success in treating gall bladder problems, and are not usually the preferred long-term treatment. Surgery is the most common and effective treatment.

Diet - Dietary changes may take a long time to have an effect, and are not always successful.

Medication - Medication may be used to successfully dissolve gall stones. This option is not available for all patients, however, and does not have a high success rate. In addition, some medications have shown serious side effects in some patients.

Extracorporeal shock wave lithotripsy - A technique called extracorporeal shock wave lithotrispy (ESWL) uses sound waves to break gall stones inside the body. Only a small number of people are considered candidates for ESWL, and success rates vary. In addition, ESWL has the potential to allow reoccurrence of gall stones.

Surgery - Surgical removal of the gall bladder is the most effective means of curing gall bladder disease because the effects are immediate, it prevents reoccurrence of the disease, and it provides a permanent long-term solution to the problem.

 

What is the most advanced and most effective treatment of gall bladder disease?

The most prevalent treatment for gall bladder disease is an advanced technique called laparoscopic cholecystectomy. Over 95% of the gall bladder surgery performed in the U.S. is done using this technique. This procedure is performed through several small incisions, about the size of a dime. The doctor uses a small, lighted instrument called a laparoscope (similar to a tiny telescope) and a camera and video monitor to obtain a magnified view for surgical removal of the gall bladder without large incisions.

The Gall-Bladder duct being clipped during laparoscopic Chlolecystectomy

 


How long will it take to recover?

Working through the small holes during laparoscopic cholecystectomy means less scarring and a much faster recovery than was previously possible with standard, large incision techniques. After laparoscopic gall bladder surgery, most patients go home after only a single night in the hospital, and resume their normal activities within five to seven days.

 

 

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YOUR EXPERTS

S K Shami MS, FRCS

S S Shoab FCPS, FRCS

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