Handling post-operative abdominal hernia
Dr S.M. Bose

AN increasing number of abdominal operations are being undertaken all over the world and this has also resulted in a rise in the number of patients with post-operative complications. One of the important and frequently seen abdominal complications is post-operative hernia, known as incisional hernia in medical terminology.

Unfortunately, this is not given the due importance or attention either by the patients or by the treating doctors; and thus is commonly neglected.

Post-operative abdominal hernia may be seen soon after operation or may take months or years for its appearance. To start with, it appears as a bulge in the abdomen just deep to the incision site, and it gradually keeps on increasing in its size. The size usually depends upon the length of the scar and also the tone of the abdominal muscles. In an old person with obesity and flabby abdomen, it may take a very big size. If not treated promptly, it keeps on increasing in size, starts hanging down from the abdomen. I have seen patients carrying on with bulges more than a football size. The implications are obvious.

The usual causes of post-operative hernia are: (1) Persistent paralysis of the intestines so that these remain dilated, giving rise to distension of the abdomen in the post-operative period. (2) Persistent increased intra-abdominal tension (pressure) because of cough, straining during the passing of urine or the passage of stools. (3) Faulty technique of abdominal closure at the time of operation. (5) Infection of the incision wound. (6) Poor nutrition of the patient so that the wound does not heal properly. (7) Paralysis of the abdominal muscles as may happen in some patients.

At times more than one cause may be responsible for the development of the hernia and at times it may be difficult to pinpoint any cause. Some of these causes are preventable and a few are not. But it is always important to inform the surgeon prior to the operation about any problem that the patient may be having, particularly about the bowel and bladder habits, so that the surgeon may be able to undertake the desired preparations prior to operation and may also take necessary measures at the time of surgery.

As mentioned above, bulge or swelling beneath the incision scar is the most important indicator of the underlying hernia and, therefore, a patient must keep on going to the surgeon for follow-up even after the healing of the operation wound or whenever the patient finds any swelling in the abdomen. Usually swelling is the only indicator of the hernia, but at times the patient may have associated problems of dragging pain, abdominal discomfort, wound infection, constipation, intestinal obstruction, etc. At times because of the pressure by the hernia, the overlying skin may be thinned out and ulceration may occur in the skin overlying a large hernia.

A fair percentage of small-sized post-operative hernias, particularly if they are not causing any problem or the patients are quite old, can be left as such with advice to come for regular check-ups to rule out the development of any complication. The obesed patients should be advised to reduce weight. Patients may be advised to use elastic corset for support. For younger patients with large unsightly hernias or with complications, the treatment is operative correction of the defect. It should be clearly understood that no amount of medicines or external measures can repair the hernia.

Pre-operative evaluation of the patient and proper preparation are necessary before undertaking operative repair. Particular attention should be given to the reduction of weight in obese patients. Cough should be brought under control by stopping smoking, breathing exercises and necessary medicines. Similarly, the problem of difficulty in passing urine and stools should also be looked into and corrected. Failure to do this may result in the recurrence of the hernia. A number of surgical techniques are available for the repair of the hernia and the surgeon should judiciously select the technique for the patient. It is now commonly believed that large defects should be repaired by implanting a mesh of non-absorbable material, the common ones being used are knitted monofilament polypropylene and polytetrafluoroethylene.

Repair of post-operative hernias is usually a difficult proposition and requires experience and expertise for successful outcome.

— The writer is a former professor of surgery, PGI. Mobile No. 98144-28229

AYURVEDA & YOU 
Some home-made summer drinks
Dr R. Vatsyayan

OF late, there is growing awareness among the general public across the world about the ill effects of frequent use of synthetically prepared drinks or of aerated cold drinks. The Genesis of many health problems has been found in the excessive use of certain chemicals, artificial colours, preservatives and some mood altering substances. With the result, people once again seem to have started searching for the natural substitutes of these drinks. It is not surprising that despite the massive publicity, the number of people who prefer not to take a carbonated or artificially prepared drink is gradually increasing.

Supported by the principles of Ayurveda, the Indians have a strong belief of adapting their kitchen and food according to the variations of seasons. Our indigenous wisdom also has it that whatever we eat or drink should be fresh, natural and friendly to the body system. With the emergence of the Unani system of medicine in India and its gradual fusion with Ayurveda a few centuries back, this tradition was further enriched. We now have a number of delicacies as home-made soft drinks, which also have immense therapeutic value.

Of the wide range of Indian summer drinks, the sharbets are most widely used and, true to their origin and meaning in the Arabic language, make a pleasant refreshment. Based on different assortments of fresh summer fruits and certain dry herbs, there is a long list of their varieties used independently or as an adjunct to enhance the effects of some other medicines. May it be the fruits like bael, mango, lichi, and phalsa or the other herbs like sandal, brahmi and khus and flowers of rose and banafsha, when used as sharbets they serve not only as a fine and natural instrument to beat the summer heat but also as very good medicines.

The pulp of fresh ripe bael fruit, available in abundance in summer, makes an instant sharbet. A foremost ayurvedic remedy to treat diarrhea, dysentery and irritable bowel syndrome, bael sharbet not only binds the loose stool but is also an effective medicine for its unstrained and satisfactory evacuation. Sharbet of mango is full of nutrients whereas of phalsa and lichi are coolants and have a soothing effect on the body system. Herbs like white sandal powder, khus and rose petals also act as excellent summer refrigerants. Far exceeding their role of home remedies, sharbets made by using these herbs are, in the true sense, drugs of choice to treat heat exhaustion, fever, excessive thirst, burning hand and feet syndrome, anxiety, depression and urinary infections.

Not lagging behind in therapeutic value, there is another home-made drink — buttermilk or the great Indian lassi. Nutritive, appetising and freshening in action, it is an acclaimed medicine for many gastro-intestinal diseases, including sprue, piles and liver dysfunction. Buttermilk can be taken with sugar or salty condiments and is an ideal summer drink, but for the forenoon sessions. Another variety called "kachchi lassi" is the drink for summer evenings. Made by dissolving just 20 ml of milk in a glass of sweetened cold water this is the most economical drink to sooth the system and allay most of the heat-related health problems.

Lime water or "shikanjvin" containing lemon, salt and sugar is a simple but all-time freshening summer drink. It is a blood purifier and helps to restore the electrolyte balance of the body. The barley "sattoo", once called the poor man’s summer drink, now seems to be recapturing the fancy of the middle and affluent classes. Mixed with a little of jaggery or shakkar, they make a very tasty, light and diuretic summer drink. The "thandai" made of almonds, khas-khas and seeds of cucumber, melon, water melon and pumpkin also come out to be soothing, nutritive and exhilarating refreshment. It is worth trying at home.

— The writer is an ayurvedic consultant based at Ludhiana, Phones 2423500, 2431500. Email: sanjivni@satyam,net.in

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