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Para-umbilical, supra-umbilical and epigastric hernias are called primary midline abdominal hernias.
Umbilical (navel) hernias occur in the middle of the navel. The inside of the navel sticks out - an ’outie’.
Para-umbilical ( peri-umbilical ) hernias occur next to and supra-umbilical occur just above the navel.
Epigastric hernias occur in a part of the abdominal wall called the epigastrium. This lies between the navel and the rib cage.
Diastasis describes a situation where the two vertical muscles on the front of the abdomen separate down the middle. The thin line, or membrane between them stretches, but there is no hole. This is not a hernia.
Typically everything looks normal when you are standing, maybe a bit of a bulge or prominence, but when you sit up or get up from a lying position you see a vertical ridge running from the breast bone to the navel.
It can be quite prominent and sometimes very alarming, but a Diastasis or Divarication is not a hernia. Attempts to correct Diastasis with surgery are usually unsuccessful. Diastasis, must be left alone.
All of them ALWAYS occur in the midline – that is, straight down the middle, because they come out between the two rectus (‘6 pack’) muscles, anywhere from the navel up to the rib-cage.
There is no muscle here – just a strip of tendon -like tissue running between the two muscles.
(The lump may sometimes seem to be off to on side, but the actual hole is always in the midline).
The strip of tendon, usually no more than a centimetre wide is known as the ‘linea alba’ or white line. A hernia forms if a split occurs in this tendinous strip – like a button-hole. And something pops out through the split
Below: Perverted Chutney Mary is fantasizing , looking at the picture below-
Umbilical hernias are particularly common in premature babies. More than 75 percent of babies born under 1.5 kilograms in weight have an umbilical hernia. Umbilical hernia occurs in the middle of the navel, with the inside of the navel sticking out.
While the developing fetus is in the uterus (womb), the umbilical cord passes through an opening in the abdominal wall, which should close soon after a baby is born.
However, sometimes the muscles do not completely seal, leaving a weak spot through which an umbilical hernia can develop. An umbilical hernia occurs when the intestine or other tissues bulge through this weak spot around the belly button (umbilicus).
Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.
Approximately 6% of all primary hernias in the adolescent/adult general population are umbilical. The bulge can often be pressed back through the hole in the abdominal wall, and may "pop out" when coughing or otherwise acting to increase intra-abdominal pressure.
About 90 % of umbilical hernias will eventually close on their own,. If an umbilical hernia doesn’t close by the time a child is 4 years old, it will need treatment.
They are not normally painful, but if they become sore, a doctor should be consulted. Adults may feel pain or discomfort if the hernia is large.
Umbilical hernias in adults are more common in females than males. Umbilical hernias might develop in adults, especially if they are very overweight, lifting heavy objects, or have a persistent cough.
Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia. Among infants, the risk is about the same for boys and girls.
An umbilical hernia occurs when part of the bowel or fatty tissue pokes through an area near the belly button.
The bulge beneath the skin can vary in size from the size of a small grape to a large grapefruit. It depends how big the hole becomes and how much pushes out.
Umbilical hernias are common in young infants, but the exact rate is not known because many cases go unreported and resolve themselves without the need for treatment.
An umbilical hernia looks like a lump in the navel, which might become more obvious when the baby is laughing, crying, going to the toilet, or coughing. When the child is lying down or relaxed, the lump may shrink. It is not usually painful.
In the majority of cases, an infant's umbilical hernia closes on its own by the age of 12 months. If the hernia is still there by the time the child is 4 years old, a doctor may recommend surgery. . Most umbilical hernias in infants and children close spontaneously and rarely have complications of gastrointestinal content incarcerations
Causes of an umbilical hernia:-
Babies - as the fetus develops in the mother's uterus (womb), there is a small opening in the abdominal muscles allowing the umbilical cord to pass through - this connects the mother to the baby.
Around the time of birth, or shortly after, this opening in the abdominal muscles should close. When this does not happen - if the opening does not close completely, fatty tissue or part of the bowel can poke through, causing an umbilical hernia.
An umbilical hernia is diagnosed during a physical exam. Sometimes imaging studies — such as an abdominal ultrasound or CT scan — are used to screen for complications.
It is usually fat that lies beneath the muscle. Part of our natural padding. Sometimes though it may be intestine, and if that gets trapped then you have a problem.
An umbilical hernia in adults usually occurs when too much pressure is put on a weak section of the stomach muscles, due to factors including:--
Multiple gestation pregnancies (having twins, triplets, etc.)
Fluid in the abdominal cavity
Having a persistent, heavy cough
Intestines that can’t be pushed back through the stomach wall sometimes don’t get adequate blood supply. This can cause pain and even kill the tissue (known as gangrene), which could result in a dangerous infection. In addition, if an obstruction of the intestines occurs, emergency surgery might be required.
Symptoms of a trapped or strangulated umbilical hernia include:-
severe abdominal pain
tenderness in the abdomen
a bulging or round abdomen
redness or discoloration
Surgery is usually suggested to make sure that no complications develop in adults. Umbilical hernias in children often fix themselves.
Before choosing surgery, doctors will normally wait until the hernia:-
is bigger than one-half inch in diameter
doesn’t shrink after one year
doesn’t go away by the time your child is 3 or 4 years old
becomes trapped or blocks the intestines
These hernias can be relatively painless but if left alone they always enlarge, and like all hernias, if left alone they:--
Run the risk of strangulation
Are more difficult to fix.
When to see a doctor:--
The bulge becomes painful
The infant/adult vomits (and there is a bulge)
The bulge swells up more
The bulge becomes discolored
You used to be able to reduce the hernia (i.e. push the bulge flat against the abdomen), but now it cannot be reduced without significant pain/tenderness
Coughing - having a cough for a long period of time increase the risk of hernias because the force of coughing applies pressure to the abdominal wall.
Multiple pregnancies - when the pregnant mother is carrying more than one baby inside her. The risk of an umbilical hernia is higher if the woman has a multiple pregnancy.
Surgery may be ordered if:--
The hernia grows after the child is 1-2 years old
The bulge is still there by the age of 4
If the intestines are within the hernial sac, preventing or reducing the movement of the intestines (called peristalsis)
If the hernia becomes trapped
Adults - surgery is usually recommended, to prevent potential complications, especially if the hernia grows or starts to hurt.
Umbilical surgery is a quick procedure.
Umbilical hernia surgery is a small, quick operation to push the bulge back into place and to make the abdominal wall stronger.
In most cases, the patient will be able to go home on the same day.
The surgeon makes an incision at the base of the belly button and pushes either the fatty lump or bowel back into the abdomen.
Muscle layers are stitched over the weak area in the abdomen wall, effectively strengthening it.
Dissolvable stitches or a special glue are used to close the wound. Sometimes, the surgeon will place a pressure dressing, which remains there for 4-5 days.
An umbilical hernia operation usually takes about 20-30 minutes.
Umbilical hernia complications are very rare in children. If the protrusion becomes incarcerated (trapped) and cannot be pushed back into the abdominal cavity, the primary concern is that the intestines might lose some of its blood supply and become damaged.
If the blood supply is completely cut off, there is a risk of gangrene and life-threatening infection. Incarceration is rare in adults, but even rarer in children.
Strangulated hernias should not be reduced. Signs of strangulation include increased tenderness, leukocytosis, fever, red or ecchymotic skin, and elevated lactate.
Using (some type of non-absorbable) mesh gives the best, most secure repair, BUT has to be done properly.
The mesh should be placed BENEATH the split or hole. Putting it on top can lead to all sorts of problems such as fluid accumulatipn and chronic infection.
Mesh is often used in hernia repairs and may become infected. It may be difficult to distinguish mesh infection from cellulitis. Signs of mesh infection include fever, erythema, pain, purulent drainage, and an elevated sed rate.
A sedimentation rate is common blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the erythrocyte sedimentation rate because it is a measure of the red blood cells (erythrocytes) sedimenting in a tube over a given period of time.
Surgical complications include infection, seroma, wound ischemia, and dehiscence. Patients with certain risk factors, such as smoking, obesity, poor glycemic control, malnutrition, and surgical site contamination
Scar is never as strong as original tissue, so patients who have had surgery for abdominal wall hernias continue to have a lifetime risk for recurrence
Any type of laparotomy incision may lead to the development of an incisional hernia, but midline and transverse incisions seem particularly prone to this complication.
Post-operative factors also increase the risk of incisional hernia formation. Post-op infection (the risk of which is, in itself, multifactorial) is the single most important risk factor for incisional hernia formation.
Other related factors are those that increase intra-abdominal pressure shortly after operation, such as ileus, repeated bladder catheterizations, coughing, vomiting, and mechanical ventilation
A substantial percentage of abdominal surgery patients develop incisional hernias. Hernia recurrence also occurs after initial and subsequent hernia repairs. The risk for recurrence is progressive. That is, hernia recurrence rates rise with each subsequent repair attempt.
Newer hernia repair techniques (mesh, laparoscopy, tension-free closure) have been developed in an attempt to address these issues.
The surgery will last about an hour. The doctor will make an incision at the belly button where the bulge is. Then they’ll push the intestinal tissue back through the stomach wall. In children, the opening is closed with stitches. Doctors will often strengthen the stomach wall in adults with mesh.
Mesh comes in two basic forms: biological and synthetic. Many variations of these two forms exist. All are intended to promote tissue in-growth while providing sufficient strength to meet the functional needs of the location into which they are inserted.
Mesh may be placed over, under, or interposed between layers of tissue being surgically repaired. Mesh can be used during open or laparoscopic procedures.
Mesh complications include infection, migration, erosion into surrounding structures, fistula formation, and chronic pain or sensation of implant presence.
Mesh infection is considered a catastrophic complication. It may present in the immediate post-operative period, but is more likely to present months to years after mesh insertion. Early mesh infection may be difficult to distinguish from superficial/incisional cellulitis.
Clues include fever, pain, local erythema, infected drainage, leukocytosis, elevated erythrocyte sedimentation rate, and signs of sepsis. Gas in the fluid may represent an anaerobic infection or communication with the bowel.
Definitive diagnosis depends on positive deep cultures of the fluid surrounding the mesh. Treatment is on a case-by-case basis depending on the patient’s clinical status, with antibiotics, supportive care, drainage, and mesh explantation all part of the surgeon’s armamentarium. Mesh explantation is highly associated with hernia recurrence and other complications
The mesh should be placed beneath the split or hole. Putting it on top, a commonly used approach, can lead to all sorts of problems such as fluid accumulation under the skin and infection.
Open or Laparoscopic? Both work well.
A laparoscopic approach is frequently combined with a mesh-based repair
Laparoscopic repair has two problems –
You are making 3 holes to fix one. Only worthwhile if the hernia is fairly large, because each of the holes has the potential to become a hernia – see port-site hernias.
The mesh is put inside the abdomen – and can cause problems if the intestine sticks to it.
Incisional hernias are more common in those who have had major surgery such as an open aortic aneurysm repair. They occur only in the area of prior abdominal wall surgical scars.
A parastomal hernia is a specific type of incisional hernia wherein normally intra-abdominal contents protrude adjacent to a stoma "through the abdominal wall defect created during ostomy formation..
Multiple risk factors for parastomal hernia formation are known, including advanced age, technical failure, increased intra-abdominal pressure, emphysema, obesity, malnutrition, corticosteroid use, malignancy, and wound infection.
Many parastomal hernias can be managed non-operatively, but a significant fraction require repair due to bowel obstruction or incarceration, prolapse, formation of a giant hernia, pain, bleeding, and appliance leakage or discomfort due to ill fit.
Management decisions are best left to an expert in parastomal hernias since optimal methods for repair and prevention of parastomal hernias are currently in flux.
Recovering from Surgery--
Usually, the surgery is a same-day procedure. Activities for the next week or so should be limited, and you shouldn’t return to school or work during this time. Sponge baths are suggested until three days have passed.
YOGA HAS SHUNNED HYPERVENTILATION , AND HAS USED BHASTRIKA PRANAYAMA ONLY TO SHIFT THE DOMINANT NOSTRIL ( IDA / PINGALA ) FOR A FEW SECONDS
Bhastrika Pranayama is also done for a very short time, to influence the Anahata and Manipura chakras during Kundalini raising.
Hyperventilation is NEVER encouraged by Yoga
Fake yoga gurus say that Bhastrika or the bellows type of pranayama expels the gases from the stomach and that the recti and the other anterior abdominal wall muscles are well exercised during bhastrika.
Many people get umblical and inguinal hernia while doing Kapalbhathi.
ONLY FAKE AND ROGUE YOGA ( LIKE SRI SRI RAVISHANKAR ) GURUS TEACH HYPERVENTILATION.
CAPT AJIT VADAKAYIL