An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Symptoms are present in about 66% of affected people.
It occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting protrusion can be painful, especially when you cough, bend over or lift a heavy object, exercise, or bowel movements. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.
An inguinal hernia isn’t necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or enlarging. Inguinal hernia repair is a common surgical procedure.
Sign & symptoms:
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. Mild discomfort can develop over time. The inability to “reduce”, or place the bulge back into the abdomen usually means the hernia is ‘incarcerated’ which requires emergency surgery.
Causes & Risk Factors:
There isn’t one cause for this type of hernia, but weak spots within the abdominal and groin muscles are thought to be a major contributor. Extra pressure on this area of the body can eventually cause a hernia.
*personal history of hernias
*being overweight or obese
*frequently standing for long periods of time
Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).
As the hernia progresses, contents of the abdominal cavity, such as the intestines, liver, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed “strangulated” and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable. Emergency surgery for incarceration and strangulation carry much higher risk than planned, “elective” procedures. However, the risk of incarceration is low, evaluated at 0.2% per year. On the other hand, surgical intervention has a significant risk of causing inguinodynia, and this is why minimally symptomatic patients are advised to watchful waiting.
There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.
Direct inguinal hernia: Enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)
Indirect inguinal hernia: Protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the processus vaginalis after the testicle passes through it.
In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall through which the intestines may protrude.
A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.
If the diagnosis isn’t readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.
If your hernia is small and isn’t bothering you, your doctor might recommend watchful waiting. In children, the doctor might try applying manual pressure to reduce the bulge before considering surgery.
Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.
There are two general types of hernia operations — open hernia repair and laparoscopic repair.
Open hernia repair:
In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue.
After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.
In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.
A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.
People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. However, some studies indicate that hernia recurrence is more likely with laparoscopic repair than with open surgery.
Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).
Some studies indicate that a laparoscopic repair can increase the risk of complications and of recurrence. Having the procedure performed by a surgeon with extensive experience in laparoscopic hernia repairs can reduce the risks.
Prevention and Outlook of Inguinal Hernias:
Although you can’t prevent genetic defects that may cause hernias, it’s possible to lessen the severity of hernias by:
*Maintaining a healthy weight
*Eating a high-fiber diet
*Avoiding heavy lifting
Early treatment can help cure inguinal hernias. However, there’s always the slight risk of recurrence and complications, such as infection after surgery, scars.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Botanical Name : Artemisia capillaries Family: Asteraceae Genus: Artemisia Species: A. scoparia Order: Asterales
Common Names : Yin Chen Hao English Name:Capillary Wormwood Herb Pin Yin Name:Yin Chen
Other Pin Yin Name:Mian Yin Chen,Bai Hao,Rong Hao,Song Mao Ai,Ma Xian,Po Po Hao,Ye Lan Hao
Habitat :Artemisia capillaries is native to E. Asia – China, Japan, Korea, Manchuria. It grows on the grassy thickets, and along rivers and seashores, C. and S. Japan. Humid slopes, hills, terraces, roadsides and river banks at elevations of 100 – 2700 metres in China.
Artemisia capillaris is a deciduous perennial herb or subshrub.Stem erect height 0.5 to 1 m,root woody,surface color yellow brown,vertical stripin,branches;seedling covered with brown silk hair,hairless when grow up.Bottom Leaf split wide and short,covered with short silky foliage;middle leaf split long and slim as hair,1mm width;top leaf split into 3 parts or no split,no hair.capitulum small and numerous,flower color yellow,pipe like,outer layer 3 to 5 bud,female,fertible,inner layer bisexual 5 to 7,infertility.Fruit long round shape width 0.8mm,hairless.Flowering during September to October.The flowers are hermaphrodite (have both male and female organs) and are pollinated by Wind.and the seeds ripen from Sep to October.
The plant prefers light (sandy) and medium (loamy) soils and requires well-drained soil.The plant prefers neutral and basic (alkaline) soils..It can grow in semi-shade (light woodland) or no shade.It requires dry or moist soil and can tolerate drought.The plant can tolerates strong winds but not maritime exposure.
An easily grown plant, succeeding in a well-drained circumneutral or slightly alkaline loamy soil, preferring a sunny position. Established plants are drought tolerant. Plants are longer lived, more hardy and more aromatic when they are grown in a poor dry soil. This species is probably not hardy in all parts of Britain, it tolerates temperatures down to at least -5°c. Plants in this genus are notably resistant to honey fungus. Members of this genus are rarely if ever troubled by browsing deer.
Seed – surface sow from late winter to early summer in a greenhouse. When large enough to handle, prick the seedlings out into individual pots and plant them out in the summer. Cuttings of half-ripe wood, July/August in a frame. Division in spring or autumn.
Yin Chen Hao has been used in Chinese herbal medicine for over 2,000 years. It is considered to be a bitter and cooling herb, clearing “damp heat” from the liver and gall ducts and relieving fevers. It is an effective remedy for liver problems, being specifically helpful in treating hepatitis with jaundice. Modern research has confirmed that the plant has a tonic and strengthening effect upon the liver, gallbladder and digestive system. The leaves and young shoots are antibacterial, anticholesterolemic, antiviral, cholagogue, diuretic, febrifuge and vasodilator. An infusion is used internally in the treatment of jaundice, hepatitis, gall bladder complaints and feverish illnesses. Externally it has been applied in the form of a plaster for treating headaches. The plant is harvested in late spring and can be dried for later use. Yin Chen Hao is contraindicated for pregnant women
Yin chen hao is an effective remedy for liver problems, being specifically helpful for treating hepatitis with jaundice. Traditional Chinese medicine holds that it is bitter and cooling, clearing “damp heat” from the liver and gall ducts and relieving fevers. Yin chen hao is also anti-inflammatory and diuretic. It was formerly used in a plaster for headaches. Research indicates that yin chen hao has a tonic and strengthening effect on the liver and gallbladder and digestive system. It is an effective remedy for liver problems, being specifically helpful in treating hepatitis with jaundice. An infusion of the young shoots is used internally in the treatment of jaundice, hepatitis, gall bladder complaints and feverish illnesses. Externally it has been applied in the form of a plaster for treating headaches.
Known Hazards : Although no reports of toxicity have been seen for this species, skin contact with some members of this genus can cause dermatitis or other allergic reactions in some people.
Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
The key element in laparoscopic surgery is the use of a laparoscope. There are two types: a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip) or a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope, eliminating the rod lens system. Also attached is a fiber optic cable system connected to a ‘cold’ light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.
Laparoscopy is a surgery that allows your doctor to see and operate on the organs inside your pelvis and abdomen through very small incisions in the abdominal wall. Many types of abdominal surgery can be done with laparoscopy, including diagnosis and treatment of infertility or pelvic pain, gallbladder or appendix removal, and tubal ligation for preventing pregnancies.
How do you prepare for the test?
Discuss the specific procedures planned during your laparoscopy ahead of time with your doctor. Laparoscopy is done by either a surgeon or a gynecologist-obstetrician. You will need to sign a consent form giving your doctor permission to perform this test.
If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.
You will be told not to eat anything for at least eight hours before the surgery. An empty stomach will help prevent the nausea that can be a side effect of anesthesia medicines. You should arrange for a ride home from the hospital if your doctor plans on sending you home on the same day.
Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.
It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902 Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure in dogs and in 1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. This innovation in technology provided the means to project a magnified view of the operative field onto a monitor, and at the same time freed both the operating surgeon’s hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very limited application and used mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.
The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths.
Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient’s navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.
In certain advanced laparoscopic procedures where the size of the specimen being removed would be too large to pull out through a trocar site, as would be done with a gallbladder, an incision larger than 10mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient’s abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.
Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.
The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception and the limited working area are factors which add to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional training during one or two years of fellowship after completing their basic surgical residency.
The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal.
Laparoscopic techniques have also been developed in the field of veterinary medicine. Due to the relative high cost of the equiment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases – everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%)than those that were spayed with traditional ‘open’ methods. Arthroscopy, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University’s School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.
What happens when the test is performed?
Laparoscopy is done in an operating room. You wear a hospital gown. You have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
You have general anesthesia for this test, which puts you to sleep so you are unconscious during the procedure. For general anesthesia, you breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube may be put down your throat to help you breathe.
During laparoscopy, a tiny camera is inserted through a very small incision (less than an inch long), usually in or just below your navel. A gas such as carbon dioxide or nitrous oxide is pumped into your abdomen to help lift your abdominal wall off of your pelvic and abdominal organs so that the camera can view them clearly. If you are having any procedure more complicated than inspection of the pelvis or abdomen, your doctor makes one or more additional incisions to allow other instruments to reach into your abdomen. For pelvic surgeries, it is common for the additional incision to be just below the pubic hair line. You should ask your surgeon where you might expect to have incisions as part of your laparoscopy.
A wide variety of instruments are useful in laparoscopy. These include instruments that can cut and place clips onto internal structures, burn away scar tissue or painful areas in the pelvis, or remove small biopsy samples or even whole internal organs (often in pieces so that larger incisions are not necessary). Your doctor can see the work he or she is doing by watching a television screen.
At the end of the surgery, the instruments are withdrawn, the gas is removed, and the incisions are stitched closed. Your anesthesia is stopped so that you can wake up within a few minutes after your laparoscopy is finished.
Advantages: There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:
*reduced haemorrhaging , which reduces the chance of needing a blood transfusion.
*smaller incision, which reduces pain and shortens recovery time.
*less pain, leading to less pain medication needed.
*Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
*reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
*can be used in Gamete intrafallopian transfer (GIFT) surgery to put the eggs back into the fallopian tubes
Risk Factors: Some of the risks are briefly described below:
*The most significant risks are from trocar injuries to either blood vessels or small or large bowel. The risk of such injuries is increased in patients who are obese or have a history of prior abdominal surgery. The initial trocar is typically inserted blindly. While these injuries are rare, significant complications can occur. Vascular injuries can result in hemorrhage that may be life threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.
*Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.
*There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of heated and humidified CO2 may reduce this risk.
*Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.
*Not all of the CO2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient’s shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration. 
*Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.
*Patients can often have trouble walking after surgery for a few days
It is easier for patients to recover from laparoscopy compared with regular abdominal surgery (often called “open” surgery) because the wounds from the incisions are so small. You will have a small straight scar (less than an inch long) wherever the instruments were inserted.
*Sometimes a small amount of the gas used to expand the abdomen will remain after the surgery for a day or two, before it dissolves away. This can cause some shoulder pain. Depending on the type of operation your laparoscopy involved, you might also have some cramping in the pelvis or abdomen. Some laparoscopy procedures in the pelvis normally cause a small amount of bleeding through the vagina. Some patients experience some nausea from the medicines used for anesthesia or anxiety.
*General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections. For laparoscopy, the risk of complications from anesthesia are smaller than average, because most surgeries done with laparoscopy are fairly simple and do not require you to have anesthesia for much longer than an hour.
Must you do anything special after the test is over?
You will be watched for a few hours after your surgery to make sure that you are recovering well. You may be asked to sit up and drink liquids. For many laparoscopic procedures, you can go home the same day. You should not drive or drink alcohol the day of your test.
You should contact your doctor if you develop a fever over 101° F, strong pain, or bleeding from the vagina that is heavier than expected.
You will have a follow-up visit with your doctor to remove stitches if needed and to make sure you are recovering well.
How long is it before the result of the test is known?
If your laparoscopy was done to look for a cause of pain or other diagnosis, your doctor can tell you right after the surgery what was seen during the test. If a biopsy sample is removed, you may have to wait several days for the report. Robotics and technology
The process of minimally invasive surgery has been augmented by specialized tools for decades. However, in recent years, electronic tools have been developed to aid surgeons. Some of the features include:
*Visual magnification – use of a large viewing screen improves visibility
*Stabilization – Electromechanical damping of vibrations, due to machinery or shaky human hands
*Simulators – use of specialized virtual reality training tools to improve physicians’ proficiency in surgery
*Reduced number of incisions
Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle. Click to enlarge->..
Non robotic hand guided assistance systems
There are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his team, regarding the need of replacing static holding force during the intervention.
Some of the features are:
*The Stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.
*Some systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18kg) and can withstand a force of 20 N in any position and direction.
*The benefit – a physically relaxed intervention team can work concentrated on the main goals during the intervention.
*The potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile and easy to use. Resources: