Hemraj has realised the necessity of proper technique and adequate support during weight lifting.

When 29 year- old software engineer Hemraj Balwaria was told he had to have surgery for hernia, he immediately recalled his father having to undergo a similar surgery five years ago followed by a painful recovery. With laparoscopy, he was surprised the same surgery would allow him to walk around in a few hours. He shares his experience with RITUPARNA MUKHERJEE, and his doctor explains the procedure

THE PATIENT
A month ago, I experienced slight discomfort on the left side of my stomach, lower down close to my pelvis. Since the pain was negligible and erratic, I ignored it. This is a big problem where Indians are concerned I think, we ignore pain till it becomes severe. That’s exactly what happened with me. I kept ignoring the pain. Then I noticed a slight swelling in my groin, so small that it was imperceptible. When I used to lie down the swelling would disappear. While going to office, I would have to sit in the car for quite a long period of time, that was when a sharp pinching pain would radiate down my stomach to my groin. This went on for some time, and the swelling began growing in size and so did the intensity of the pain. I could no longer ignore this and realised that I had all the symptoms of a hernia, something my father had suffered.

The doctor confirmed that the growth was a hernia and I would need surgery. Based on my father’s experience five years ago, I thought I knew what to expect. In his case the affected area was opened and the hernia defect was stitched up with sutures. There was considerable trauma after surgery for two weeks because of the stitches. So I was pleasantly surprised to be told that the hernia procedure today would allow me quick recovery and I could go home in 24 hours time. After being admitted to the hospital I underwent a couple of routine tests for blood and urine. Then the area from my stomach till my knees were shaved. While that was a bit uncomfortable, I took it as a part of the operation. For the surgery the next morning I was taken straight to the operation room. After I was given anaesthesia, I don’t recall anything. When I came to my senses post operation, sitting up and walking entailed some pain, as the area that had been operated upon felt stretched. For a day, I faced a problem going to the bathroom. I did not feel the urge to go to the loo, and I found that I could not sense the fact that I was passing urine when in fact I was. Doctors told me this was because of the anaesthesia. However, the next day, I was able to go to the toilet normally, even though I still needed help to sit and turn over. Lying down flat on my back or standing straight was also problematic. The doctors also forbade me to laugh loudly or shout as that would strain the operated area. Coughing or sneezing became quite a problem- if I happened to cough the pain was blinding! But gradually the pain reduced. Three days later I was able to drive myself to work!

I was on medication for a few days, the mandatory antibiotic course of three days, and then for five days I was on oral medication prescribed by the doctor. When I compare my surgery to my father’s I am even more amazed. My father’s surgery was followed by a week- long recovery, and he has a large scar to show for it, where as I began walking the evening of my surgery and driving the next day. So obviously I am finding it a bit difficult to convince my family that despite having a surgery I am fine now and able to go to work.

The doctor said the hernia could have been caused by over exertion at the gym. I had stopped working out for two years and then four months ago, I decided to try lifting weights again. I am sure I must have lifted too much and strained myself. I wonder if men who do heavy lifting are aware of the consequences and take adequate precautions, because that is essential.

THE DOCTOR
Dr Randeep Wadhawan is a senior consultant surgeon, laparoscopy, Fortis Hospital, Vasant Kunj.

He says: Hernia of the groin is a common problem in all age groups. It can occur in younger children (from birth), in young men (who lift weights without support), and the elderly(whose muscle walls weaken with age). The extra pressure put on the abdominal wall due to lifting heavy weights can result in hernia. Heavy weights should always be lifted with knees bent, that way pressure is not put on the abdominal region, and use of supporting pads is also advised. Those who are middle aged and older may suffer from hernia due to muscle weakness, or if they are suffering from chronic cough or constipation. Hernia is a condition when soft tissue - usually part of the intestine - protrudes through a weak point or tear in the lower abdominal wall.

If a segment of intestine gets trapped in the scrotum, the blood supply may be cut off, and the segment of intestine may become gangrenous in as little as six hours. So hernia can be dangerous if untreated.

During surgery, a mesh of synthetic fibre is sewn over the weakened muscle. The easiest way to understand this is to imagine a gas pipe with a hole. If you cover the hole on top, then there is a chance that the covering might get loose due to pressure of the gas. But if you cover the hole from within, even if there is pressure inside the pipe, the covering will be able to withstand the pressure.

This surgery can also be done laparoscopically, which is what we did for Hemraj. We made three tiny incisions in Hemraj’s stomach, one measuring 1 cm, the other two measuring 5 mm each, through which we inserted a telescopic camera and advanced laparoscopic instruments. We treated the hernial defect and reduced the content of the hernia till the swelling was no more. After that we placed the mesh, which serves to close the gap caused by the hernial defect. The mesh is stapled to the ligament inside so that it is not dislodged. The three holes that were made for the surgery are then stapled with metal pins made of titanium (a substance that does not react with the body).

Laparoscopy allows excellent recovery and like other patients, Hemraj was walking about within hours of the procedure.

Note: Recurrence of hernias (the true measure of hernia repair) according to some studies is Power with the traditional open method than ft is with Laparoscopy other studies show that hernia repaired laparoscopically has a smaller rate of recurrence. The conventional (open) hernia surgery Is still common In India. it is cheaper, though ft takes a few days longer for recovery, and is considered the gold standard by many surgeons. The outcome of either surgery depends on the type of repair and the expertise of the surgeon.