Hernia Treatment & Surgery in Gandhinagar & Ahmedabad | Niraaya Hospital

Umbilical hernias occur at the umbilicus (belly button) - a natural point of fascial weakness where the umbilical vessels passed through the abdominal wall during fetal life. In infants, small umbilical hernias (less than 1.5 cm) often close spontaneously by age 3-5 and are observed conservatively. In adults, umbilical hernias do not close on their own and require surgical repair.

Adult umbilical hernias are more common in women (particularly following multiple pregnancies), obese individuals, patients with chronic raised intra-abdominal pressure (chronic cough, constipation, ascites), and those who perform heavy manual labour. The hernia contains omentum (fatty tissue) or occasionally a loop of bowel, and presents as a round swelling at or around the navel - often with an aching discomfort.

An incisional hernia is a hernia that develops at the site of a previous abdominal surgical wound. Every abdominal incision represents a potential weakness in the abdominal wall - and when the wound does not heal adequately (due to infection, poor nutrition, obesity, steroid use, or excessive early straining), the fascial edges separate and the abdominal contents push through.

Incisional hernias can develop weeks, months, or even years after the original surgery. They may be small initially but tend to enlarge progressively. Large incisional hernias can cause significant cosmetic deformity, discomfort, difficulties with physical activity, and a serious risk of bowel incarceration.

Repair requires careful pre-operative planning - CT abdomen helps assess the size of the defect and the quality of surrounding fascia. Laparoscopic IPOM repair using a composite mesh is the preferred technique for most incisional hernias. Very large hernias with significant loss of domain may require component separation surgery - a specialised abdominal wall reconstruction technique - which Dr. Patel is trained to perform.

Femoral hernias protrude through the femoral canal - a small space just below the inguinal ligament through which the femoral vessels pass from the abdomen into the thigh. They are more common in women (due to the wider female pelvis) and though less common than inguinal hernias, they carry a disproportionately high risk of strangulation - because the femoral canal is a tight, rigid ring that does not expand easily when bowel pushes through it.

Many femoral hernias are initially small and asymptomatic, discovered incidentally or presenting only with a small groin lump. Because of the high strangulation risk, all femoral hernias - once identified - should be repaired without delay, regardless of symptoms.

Epigastric hernias occur through the linea alba - the fibrous midline structure connecting the two rectus abdominis muscles - in the upper abdomen between the navel and the lower chest. They typically contain preperitoneal fat (not bowel) and present as a small, firm lump in the upper midline, often tender on palpation.

While usually small and not immediately dangerous, epigastric hernias cause discomfort, particularly during physical exertion, and can enlarge over time. Surgical repair with mesh or suture (depending on size) is recommended for symptomatic hernias.

A hiatal hernia occurs when part of the stomach slides upward through the oesophageal hiatus - the opening in the diaphragm through which the oesophagus passes - into the chest cavity. Unlike groin or abdominal wall hernias, hiatal hernias are not visible externally.

Sliding hiatal hernia (Type I - most common): The gastro-oesophageal junction and upper stomach slide intermittently above the diaphragm. Strongly associated with gastro-oesophageal reflux disease (GERD) - causing chronic heartburn, regurgitation, chest pain, and chronic cough. When GERD is severe or does not respond to proton pump inhibitor medication, laparoscopic fundoplication (wrapping the upper stomach around the lower oesophagus to restore the anti-reflux mechanism) is the definitive surgical treatment.

Para-oesophageal hernia (Types II-IV): The gastro-oesophageal junction remains in place but the fundus of the stomach (and sometimes other abdominal organs) herniates into the chest beside the oesophagus. Large para-oesophageal hernias carry a significant risk of gastric volvulus - twisting of the stomach - a serious emergency. Elective laparoscopic repair is recommended even in asymptomatic cases to prevent this complication.

A recurrent hernia is one that returns after a previous surgical repair. Recurrence can occur after both open and laparoscopic hernia repairs, though rates are lower with mesh-reinforced laparoscopic techniques. Factors increasing recurrence risk include: inadequate mesh overlap or fixation, wound infection after the first repair, ongoing raised intra-abdominal pressure (obesity, chronic cough), and technical errors.

Recurrent hernias are technically more challenging to repair than primary hernias - due to scarring from the previous operation, distorted anatomy, and the need to dissect through previously placed mesh. Dr. Neel Patel has specific training and experience in recurrent hernia repair, using laparoscopic or robotic approaches to navigate scarred tissue planes with precision and place mesh in a tension-free position.

Complex abdominal wall hernias include: large incisional hernias with significant loss of abdominal domain (where the contents of the hernia can no longer be replaced in the abdominal cavity without tension), multiply recurrent hernias with extensive scarring, hernias in patients who have undergone multiple previous abdominal surgeries, contaminated field hernias (where standard synthetic mesh cannot be used), and hernias in morbidly obese patients.