Does Your hernia wet your cornea?

What is a hernia? Do you have it? If you do have it, how do you know? Is it painful? Is it hereditary? What exactly causes it? Does the belly bump cause hernia, the lump? Do you need surgery to correct it? So many questions! Let’s start by addressing the first one.

What are the different types of hernia? Depending upon the site of the uneventful, there are different types of hernias. An umbilical hernia, femoral hernia, incisional hernia, epigastric hernia, and hiatal hernia. In this article, an inguinal hernia is being discussed.

A Hernia – It’s an abnormal protrusion of an organ or part of it through a weak point in the body. An inguinal hernia is the most common one among hernias, affecting mainly men than women in 7:1 ratio, respectively. You don’t want equality in these matters, ladies, trust me! A hernia can be direct or indirect. In GOT (game of thrones), remember Hodor? The scene where the white walkers attack Bran and they’re running for their lives? Hodor holds the door So that the white walkers don’t kill Bran and turn him into one of them. If Hodor played security at the entrance of the tower and the white walkers still got in? It would be an indirect hernia. Here, the white walkers can be the abdominal viscera mainly the colon and Hodor is the deep inguinal ring. Similarly and also how it happened in GOT, Hodor stood at the back door of the tower and white walkers crawled out eventually. Here, it’s a direct hernia and the iconic Hodor, being the posterior wall of the inguinal canal.  

What is this inguinal canal? It is a muscular canal containing structures running through it. They are the spermatic cord (in males), round ligament (in females), Ilioinguinal nerve, there is a genital branch of what’s called a genitofemoral nerve and lastly remnant of processes vaginalis. The weak area of all groin hernias is the site between the inguinal ligament and the iliopubic tract called the myopectineal orifice of Fruchaud.

What causes a hernia? Sometimes, people are born with it. There can be a collagen disorder due to which the ligaments become weak, the prune-belly syndrome is congenital and acquired collagen deficiency is due to smoking. Yes, smoking not only causes cancer but also a hernia. They forgot to put that on the pack. Basically, anything increasing the intra-abdominal pressure adds to the causation of a hernia like coughing, constipation, ascites, obesity, pregnancy, straining during micturition and lifting heavy weights. Hernia cases have been recorded post appendectomy as well.

Younger you are an indirect hernia is a possibility and older you get a direct hernia occurs. An inguinal hernia usually presents itself as a groin swelling and is painful in nature and it might be radiating to the umbilical region.

Normal investigations are done for diagnosis are,

·                     The routine blood tests and urine examination. The elderly might need an additional bunch few tests like a chest X-ray, ECG, and PFTs. Urinary complaints are checked for prostatic enlargement and urethral problems.

·                     Ultrasound can detect a sac where a hernia cannot be diagnosed by clinical assessment. It is useful in postoperative swellings, hematoma, and recurrence.

·                     CT (computed tomography) for giant hernias.

·                     MRI (magnetic resonance imaging) is ideal for a sportsperson, to differentiate between muscle spasm and a hernia.

Treatment for a hernia depends on its presentation. Herniotomy, herniorrhaphy, and hernioplasty are the three important operative techniques which are performed. For adolescent patients with a hernia, herniotomy is preferred.

Herniorrhaphy - Modified bassini’s herniorrhaphy is in practice now for patients who have a good muscle tone with an indirect and direct hernia. In this procedure, the surgeon repairs the stretched out ligament and herniotomy is also conducted. Shouldice repair is another type of herniorrhaphy where herniotomy is done with correction of a hernia using the surrounding tissues by absorbable and non-absorbable sutures in different layers.     

The third operative method is the hernioplasty, which is done in patients with or without good muscle tone having an indirect or a direct hernia and also in a recurrent hernia. This approach is done so as to strengthen the posterior wall of the inguinal canal. Firming up is done by repairing the weak posterior wall by a prolene mesh or Marlex mesh. A thick fibrous layer is hence formed as it acts as a foreign body and our immune system provides the required cement to it. An artificial deep ring is also done. This mesh technique is quietly brilliant as it has a long life, preferably socioeconomic; risk of infection is minimal when handled in a sterile environment and also due to its amazing biocompatibility. Prolene darning is also done in a few cases, which is basically sewing up the loose ends and making it stronger.

There are few other techniques like the Kuntz operation usually done in elderly, Mcvay, Nyphus repair, Stoppa repair, Marcy repair. Newer advancements are game-changing procedures like the Dasarda technique, creating a hernia system which is exceptional and mesh plug repairs are gaining popularity as they have much better patient compliance.

List of hernia surgeries.

Laparoscopic surgery or open surgery? In my opinion, open is a better choice for this condition. But both have their own pros and cons. Open surgery does interfere with the bowl function. Also, if there are any complications during the laparoscopic surgery the surgeon would have to open up and go old school. Plus, open surgeries are cheaper as compared to laparoscopic but the recovery period varies indistinguishably.

Complications are often common after a surgery. They can be during, before or after the surgery. They aren’t worrisome but few need to be attended by the surgeon. Care must be taken to avoid post-operative wound infection by the patient or their caretakers. In very few cases patients complain of lower abdominal pain a characteristic dragging pain months after surgery which might be due to injury to the surrounding nerves. This is treated by nerve blocks with anesthetic agents and steroidal injections.

If a hernia is not treated at the right moment it can give rise to a number of complications which are troublesome like,

·                     An obstructed a hernia.

·                     A strangulated hernia is quite notorious as it can cause shock and sepsis and need immediate surgical care as the bowel might get gangrenous.

·                     A Sliding hernia is an incarcerated hernia in which the fecal matter may slide into it.

·                     Inflammation is yet another impediment which might range out from a simple hernia to a life-threatening one.

·                     Recurrent hernia is common is 10 percent of the lot who has been treated earlier.

With all due advancements in the surgical and medical field hernia is one of the most common cases till date which need effective, relentless and instantaneous treatment. So, don’t ignore a lump because it is not so Gump.

Written By (Dr) Apoorva Manjunath

When something that you love makes you weak in the knees!

Before your mind runs wild, let me make it clear that this isn’t completely dirty and painful. Or is it? Each person is on their own, picking up what they like and love persuading towards that particular activity. While you’re at it, doing what you love there are often times when a small misjudgment or a miscalculation might end up giving months of terrible and excruciating pain. One such incident might be A LIGAMENT TEAR.

Ligament tear usually occurs in the joints of our body when a great force is applied to a particular joint. Let’s focus on the knee joint as of now. The knee joint has 4 ligaments namely,

• Anterior cruciate ligament(ACL)
• Posterior cruciate ligament(PCL)
• Medial cruciate ligament(MCL)
• Lateral crucial ligament(LCL)

These ligaments hold the knee joint in place and help in locking and unlocking the joint. When you walk, run, dance, gym or jump these ligaments work continuously. When the knee joint is locked, the greater force applied on it ends up tearing the ligament depending upon the direction of this unaided force.

Injury to PCL - Ligament tears are also common in a road traffic accident. Usually, in a car accident, the posterior cruciate ligament is torn. The harm occurs when the tibia is forced back to the femur. This is rather rare in a sports person whose anterior cruciate ligament is at risk.

Injury to ACL - Twisting a semi-flexed knee, which already made you say “ouch” is quite cumbersome to deal with as it often causes injury to the medial meniscus and MCL. (O’Donoghue triad)

Injury to MCL – Any force the pushes the tibia towards the femur in an inside fashion causes the rupture of this ligament.

Injury to LCL – MCL, and LCL are attached to either side of the joint, media is on the inner side and lateral on the opposite. So the damage to the lateral ligament occurs when the force is applied to adduct the tibia to the femur.

So now, describing the proper anatomy. The knee joint is a hinge joint.

A hinge joint is one which is made up of more than 2 bones and moves along one axis only. Elbow joint is another such synovial joint. Knee joint consists of the tibia and the femur, a tibiofemoral joint. Then there is patella which glides over the front of the tibial end of a femur, forming the patellofemoral joint. The knee Ligaments act like the joint’s best friend, providing support and stability. When this harmony is disturbed, a painful unstable state happens to be.

The ligament injury can be associated with,

• Chipping of the bone to which the ligament it is attached.
• A mid-substance tear ( tear in the ligament)
• Severity may vary on the tear being complete or incomplete.
• One ligament involvement or more.

The combination depends upon the force acting on the joint. More severe the injury more intricate the treatment regimen gets.

Diagnosis can be made through clinical examination and a detail on the event of the grievance. Complications that present with the tear are dislocation of the joint, blood clots, swelling. The pain may be localized over the torn ligament. Radiological examination of the knee joint is important to check if the bone has been chipped off, which might have been avulsed from the ligament attachment. Contrary to the Stress X-rays, MRI is a non-invasive method to diagnose ligament injuries. The arthroscopic examination may be needed in a few cases.

Treatment of this condition was conventionally done by non-operative methods. Now that there are better techniques and with the recent advances, better results are achieved through operative reconstruction. Operative reconstruction has become popular in high demand athletic individuals like Tom Brady, Alex Morgan Adrian Peterson and a lot more NBA players. Celebrity or not we are all made up of the same cells and same anatomy and ligament injury can be treated and normal functioning of the knee can be obtained and hence decreasing your time not spent on doing what you love.

Methods that are undertaken are,

• Conservative method – The blood clot/ hematoma is aspirated and the knee is immobilized in a cylinder cast or a knee immobilizer. If the injury is grade I or grade II, a conservative method is successful for treatment. Followed by this, strengthening physiotherapy is required.

• Operative methods – These are to be done when there is a combination of ligament injuries, involving multiple ligaments especially in young athletes or dancers. Usually, the surgery is done 2-3 weeks after the injury when the inflammation is fairly reduced.

What do the surgeons do actually? They first go by repairing the ligament. It is performed on grade III ligament tears, which means the ligament is completely torn. If the surgery is done after the 2-3 weeks, an additional reinforcement is provided by a tendon or fascial graft as the original torn ligament would have lost the strength due to a complete tear.

https://surgeryxchange.com/best/acl-surgery-cost-in-bangalore

they reconstruct the unstable knee injuries which present later than usual. An allograft or an autograft of a tendon or a fascia lata is used; a synthetic graft can also be used. Auto is better than also as there are lesser chances of rejection.

Knee ligament tears are very common and are often undiagnosed. Ligament tears are usually not seen on X-rays and might get neglected. The usual presenting symptom is the instability of the knee joint. Treatment is biased depending upon the activity level of the patient. If you’re a ninja then you’ll probably need surgery. If you’re a person who probably has a sedentary lifestyle, the doctor might perhaps recommend physiotherapy. Usually, the ACL tends to get damaged more often than the others. ACL reconstruction is done with the help of an autograft and bio-absorbable screws. Arthroscopic ACL reconstruction is the surgery of choice as it is minimally invasive, and results are outstanding as the patients revert back to normal with negligible risks.

By (Dr) Apoorva Manjunath

Should you get a mammogram and if so when?

Worldwide, breast cancer is the most common cancer (other than skin cancers) and the second most common cause of cancer deaths among women.

Screening with mammography is recommended based on age, risk factors and overall benefit to the patient. Large Trials conducted in the Western population have shown about a 20% reduction in the likelihood of dying from breast cancer with annual screening mammography. 

Typically, this is recommended starting at age 50, every other year for women at average risk. Between 40-50 years of age, the recommendations are individualized based on the risk factors for the patient. A baseline at age 40 and then every 2-3 years until age 50 may be a reasonable option. The age of cut off for mammography is not clear. It is not so much the numerical age as the physiologic age of the patient that matters. However, there is no clear-cut benefit beyond age 75.

This does not apply to high-risk patients such as patients with a gene e.g., BRCA mutation who may need MRI screening yearly along with mammography starting at earlier ages. Patents with 2-4 fold increase risk of breast cancer should also consider yearly mammogram between ages of 50-75 and every other year starting at age 40.

Risk factors typically include genetic mutations such as BRCA, early onset of menstrual cycles, late onset of menopause, late or no childbirths etc. 

So, why the controversy regarding screening when studies have shown a decrease in mortality? Some of this comes from the potential complications with all screening, such as false positive mammogram possibly leading to anxiety, more frequent imaging, unnecessary biopsies etc. there is a small radiation exposure associated with mammography which in itself can lead to a small risk of breast cancer over a number of years

When routine mammographic screening was first introduced in the US, there was an increase in the incidence of breast cancer, more cancers were diagnosed which has led to the concept of “over diagnosis”. Are we diagnosing small cancers, which may never truly cause any problems during the life span of a woman? Currently, there are no methods available to determine which early cancers may progress to actually cause life-threatening problems in a woman.

This is of major concern as it may lead to treatments such as surgery, radiation etc which may result in harm.

Mortality from breast cancer has been declining over the last few years; some of this has been attributed to screening, but also to the major advances in treatment. The argument is made that patients diagnosed without screening will also likely survive breast cancer with modern day treatments.

However this generalization does not take into account that without awareness of screening and education as well as close relationship with a family physician or gynecologist many of these cancers may be diagnosed at a late stage leading to increased mortality once again from breast cancer. We have made too much progress to return to Ground zero. There should be a well thought out, individualized plan for each woman in conjunction with her Primary provider taking into account her risk and preferences. Mammography guidelines serve as a good template for such a tailored plan.

Where to find best hospitals, best options for surgeries in India ?

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