Appendicitis

Our Approach In Managing Appendicitis

Repair the weakness. Reinforce the wall. Return to full activity.

A hernia does not heal on its own - once the abdominal wall has weakened enough to allow tissue to protrude through it, only surgical repair restores the structural integrity needed to prevent progression and complications. The decision is rarely whether to repair a hernia, but when and how - and this is precisely where experienced surgical judgement matters most.

At Shree Hospitals, our approach to inguinal and umbilical hernia diagnosis and care is built on accurate clinical assessment, evidence-based technique selection, and a strong emphasis on minimally invasive repair wherever appropriate. Our hernia repair specialists evaluate every patient individually - considering hernia size, location, symptom severity, and patient activity level - before recommending the most suitable surgical approach.

1. Clinical Assessment & Diagnostic Confirmation

• Detailed physical examination - assessing hernia reducibility, size, and the presence of cough impulse
• Ultrasound abdomen and groin - confirming hernia content, ruling out other causes of swelling, and assessing for occult or small hernias
• CT abdomen for complex, recurrent, or incisional hernias requiring detailed anatomical mapping before surgery
• Assessment of abdominal wall weakness extent - including associated rectus diastasis or multiple defect sites
• Risk stratification for emergency presentation - identifying signs of incarceration or strangulation requiring urgent surgical intervention

2. Watchful Waiting for Selected Cases

    

   Not every hernia requires immediate surgery:

• Small, asymptomatic, easily reducible hernias in elderly or high-risk patients may be appropriate for surveillance
• Clear patient education on warning signs of incarceration - sudden pain, inability to reduce the hernia, vomiting, or skin colour change over the bulge
• Truss or supportive garment use as a temporary measure for patients awaiting elective surgery or those medically unfit for immediate intervention
• Regular review to reassess hernia size and symptom progression - surgery recommended promptly if any change occurs

3. Laparoscopic Hernia Repair

    

   Minimally invasive hernia surgery is our preferred approach for the majority of patients:

• Totally Extraperitoneal (TEP) repair for inguinal hernia - mesh placed without entering the abdominal cavity, minimising visceral injury risk
• Transabdominal Preperitoneal (TAPP) repair - laparoscopic access through the abdominal cavity with peritoneal closure over the mesh
• Laparoscopic ventral and incisional hernia repair - particularly beneficial for patients with large abdominal wall defects
• Three to four small keyhole incisions - significantly reduced post-operative pain compared to open surgery
• Faster return to work and physical activity - typically 1 to 2 weeks for laparoscopic repair versus 3 to 4 weeks for open surgery

4. Open Hernia Repair & Mesh Surgery

    

   For certain hernia types and patient circumstances, open repair remains the most appropriate technique:

• Lichtenstein tension-free mesh repair - the gold-standard open technique for inguinal hernia with excellent long-term outcomes
• Open umbilical and paraumbilical hernia repair - direct approach with mesh reinforcement for defects above 2 cm
• Component separation technique for large, complex incisional hernias - restoring abdominal wall function in patients with significant tissue loss
• Lightweight, macroporous synthetic mesh - used as standard across all laparoscopic hernia repair and mesh surgery in Mumbai procedures, offering durability with reduced chronic discomfort
• Local, spinal, or general anaesthesia options tailored to patient fitness and hernia complexity

5. Emergency Hernia Management

    

   Strangulated or incarcerated hernias require urgent surgical intervention:

• Same-day emergency surgery for irreducible hernias with signs of bowel compromise
• Bowel resection when strangulation has caused tissue non-viability - performed in the same surgical setting as hernia repair
• Pre-operative resuscitation and stabilisation in our emergency department before urgent theatre transfer
• Close post-operative monitoring for patients undergoing emergency bowel-involving hernia repair

6. Post-Operative Recovery & Recurrence Prevention
    

• Structured post-operative pain management - multimodal analgesia minimising opioid requirement
• Early mobilisation encouraged from the day of surgery - reducing complications and accelerating recovery
• Activity guidance - avoiding heavy lifting for 4 to 6 weeks post-repair while gradually increasing activity levels
• Weight management and chronic cough or constipation treatment - addressing modifiable risk factors for hernia recurrence
• Long-term follow-up to monitor for recurrence, particularly in patients with risk factors such as obesity or chronic straining