Dr. Sanjay Kolte, a general surgeon based in India who specializes in laparoscopic, Thoracoscopic, gastrointestinal, Emergency and General surgery. It is not intended to replace the consultation between you and your surgeon, which is vital for determining and making decisions about any treatment or surgery you may require. We are always open to suggestion or feedback on how it could be better. Thank you for taking the time to explore our practice.

1. HERNIA

2. DEFINITION OF HERNIA
A hernia is a protrusion of an organ or structure through a defect in the
mascular wall of the abdomen. Hernia are generally composed of
the covering skin and subcuteneous tissues, a peritoneal sec, and
the underlying viscera, such as loops of bowel or other internal
organs. Hernia may be congenital,cause by structural closure
defect, or acquired.

3. TYPES OF HERNIA
 UMBILICAL HERNIA
 INGUINAL HERNIA
- Indirect inguinal hernia
- Direct inguinal hernia
 FEMORAL HERNIA
 INCISIONAL HERNIA

4. UMBILICAL HERNIA
 An umbilical hernia occurs when part of the intestine protrudes
through an opening in the abdominal muscles. Umbilical hernias are
most common in infants, but they can affect adults as well. In an
infant, an umbilical hernia may be especially evident when the infant
cries, causing the baby's bellybutton protrude. This is a classic sign
of an umbilical hernia.
 Most umbilical hernias close on their own by age 1, though some
take longer to heal. To prevent complications, umbilical hernias that
don't disappear by age 4 or those that appear during adulthood may
need surgical repair.
 Umbilical hernia is a common and typically harmless condition

5. CAUSE
 During pregnancy, the umbilical cord passes through a small
opening in the baby's abdominal muscles. The opening normally
closes just before birth. If the muscles don't join together completely
in the midline of the abdomen, this weakness in the abdominal wall
may cause an umbilical hernia at birth or later in life.
 In adults, too much abdominal pressure can cause an umbilical
hernia. Possible causes in adults include:
Obesity
Heavy lifting
A long history of coughing
Multiple pregnancies
Fluid in the abdominal cavity (ascites)

6. SYMPTOMS
 Soft swelling or bulge near the navel (umbilicus).
 The bulge may range from less than 1/2 inch to about 2 inches
(about 1 to 5 centimeters) in diameter.
 Baby will crying because pain
 The baby begins to vomit
 The bulge becomes tender, swollen or discolored

7. INGUINAL HERNIA
 An inguinal hernia is a condition in which intra-abdominal fat or
part of the small intestine, also called the small bowel, bulges
through a weak area in the lower abdominal muscles. An inguinal
hernia occurs in the groin—the area between the abdomen and thigh.
This type of hernia is called inguinal because fat or part of the
intestine slides through a weak area at the inguinal ring, the opening
to the inguinal canal.
 An inguinal hernia appears as a bulge on one or both sides of the
groin. An inguinal hernia can occur any time from infancy to
adulthood and is much more common in males than females.
Inguinal hernias tend to become larger with time.

8. AN INGUINAL HERNIA SHOWING
THE SMALL INTESTINE
DESCENDING THROUGH THE
INGUINAL CANAL.

9. CAUSE
 The two types of inguinal hernia have different causes.
Indirect inguinal hernia
Indirect inguinal hernias are congenital hernias and are much more common
in males than females because of the way males develop in the womb. In a
male fetus, the spermatic cord and both testicles—starting from an intra-
abdominal location—normally descend through the inguinal canal into the
scrotum, the sac that holds the testicles
 Sometimes the entrance of the inguinal canal at the inguinal ring does not
close as it should just after birth, leaving a weakness in the abdominal wall.
Fat or part of the small intestine slides through the weakness into the inguinal
canal, causing a hernia. In females, an indirect inguinal hernia is caused by
the female organs or the small intestine sliding into the groin through a
weakness in the abdominal wall.
 Indirect hernias are the most common type of inguinal hernia. Premature
infants are especially at risk for indirect inguinal hernias because there is less
time for the inguinal canal to close.

10. Direct inguinal hernia
Direct inguinal hernias are caused by connective tissue degeneration of the
abdominal muscles, which causes weakening of the muscles during the
adult years. Direct inguinal hernias occur only in males. The hernia involves
fat or the small intestine sliding through the weak muscles into the groin. A
direct hernia develops gradually because of continuous stress on the
muscles. One or more of the following factors can cause pressure on the
abdominal muscles and may worsen the hernia:
 sudden twists, pulls, or muscle strains
 lifting heavy objects
 straining on the toilet because of constipation
 weight gain
 chronic coughing
Indirect and direct inguinal hernias usually slide back and forth
spontaneously through the inguinal canal and can often be moved back into
the abdomen with gentle massage.

11. SYMPTOMS
 Symptoms of inguinal hernia include
 a small bulge in one or both sides of the groin that may increase in size and
disappear when lying down; in males, it can present as a swollen or enlarged
scrotum
 discomfort or sharp pain—especially when straining, lifting, or exercising—
that improves when resting
 a feeling of weakness or pressure in the groin
 a burning, gurgling, or aching feeling at the bulge

12. FEMORAL HERNIA
 A femoral hernia is a bluge in the upper part of the thigh near the groin.
 A hernia occurs when the contents of the abdomen (usually part of the small
intestine) push through a weak point or tear the thin muscular wall of the
abdomen, which holds the abdominal organs in place.
CAUSE
Most of the time, there is no clear cause of a hernia. Some hernias may be present at
birth (congenital), but are not noticed until later in life.
Some factors that contribute to the development of a hernia include:
Chronic constipation
Chronic cough
Heavy lifting
Obesity
Straining to urinate because of an enlarged prostate
Femoral hernias tend to occur more often in women than in men.

13. SYMPTOMS
 You may see a bulge in the upper thigh next to the groin.
 Most femoral hernias cause no symptoms. There may be some groin
discomfort that is worse when you stand, lift heavy objects, or strain.
 Sometimes, the first symptoms are abdominal pain, nausea, and
vomiting. This may mean that the intestine is blocked, which is an
emergency.

14. INCISIONAL/VENTRAL HERNIA
 A hernia is the protrusion of an organ through the wall that normally
contains it. An incisional hernia occurs in the abdomen in the area of an old
surgical scar. A part of an organ in the abdomen, such as the bowel or
intestines, protrudes through the weakened area of the abdominal wall.
CAUSE
 incisional hernias are caused by thinning or stretching of scar tissue that
forms after surgery. This weakened scar tissue then creates a weakness in
the abdominal wall.
 Excessive weight gain, physical activity that places pressure on the
abdomen, pregnancy, straining during bowel movements because of
constipation, severe vomiting, or chronic and intense coughing causes the
scar tissue to thin or stretch. Because the abdominal wall is weak, the
hernia occurs during abdominal strain.

15. SYMPTOMS
 An incisional hernia causes a bulge in the abdominal area. This type
of hernia is often painless, but may be tender and can cause
discomfort during any type of physical strain, such as lifting or
coughing. The bulge may disappear when the patient is lying down,
and be more visible when standing up. A hernia can often be pushed
gently back into place.
 This is called a reducible hernia. When a hernia cannot be pushed
back into place, it means a piece of the organ has become trapped, or
incarcerated. Symptoms include pain, nausea, vomiting, inability to
have a bowel movement, and a bulge that remains even when lying
down.
 When a portion of an organ is incarcerated, its blood supply can be
cut off, which means the organ’s tissue will die. This condition is
called a strangulated hernia. Incisional hernias can increase in size
with time.

16. MBBS - OCTOBER 1995-BHARATI VIDYAPEETH'S MEDICAL COLLEGE, PUNE,
INDIA
FCPS (General Surgery) - SEPTEMBER 2000, MUMBAI, INDIA
(FELLOW OF COLLEGE OF PHYSICIANS AND SURGEONS)
DNB (General Surgery) - MAY 2001-KING EDWARD MEMORIAL HOSPITAL,
PUNE, INDIA (DIPLOMATE OF NATIONAL BOARD, NEW DELHI)
MNAMS - MEMBER OF NATIONAL ACADEMY OF MEDICAL SCIENCES, NEW
DELHI
Contact Details:
Laparoscopic Surgery Clinic, Parihar Chowk, Aundh,
Pune, Maharashtra 411007
Mobile : 91 +98 2200 94 90
Email : doctorsanjaykolte@gmail.com
http://www.drsanjaykolte.in/