Hernia

What is a Hernia?

The symptoms depend on the type of hernia, its causes and the severity. .

A hernia is a bulge or protrusion of an organ or fatty tissue through a weakened area in the muscle or connective tissue in which the organ is enclosed.

A hernia can develop in any part of the body. However, the muscles of the abdominal wall are most commonly affected.

Who is Affected By a Hernia?

Hernia can occur in babies and in adults. Hernia in babies usually heals by itself within four years, but for others, hernia repair surgery is the standard treatment.

What are the Symptoms of a Hernia?

The main symptom is the appearance of a lump (a swollen area) in the region involved. The lump may be painless and only be felt on exertion such as lifting heavy objects, coughing, etc. Some hernias can cause pain during exertion.

The lump may not be seen or felt when the person is lying down; it becomes prominent on standing and particularly on straining. Some hernias can get strangulated, interrupting blood supply to the herniated tissue.

A hernia may cause pain or discomfort.

Hernia Diagnosis

A hernia can usually be diagnosed by physical examination (for example: for inguinal hernia, a lump can be seen or felt in the groin).

Ultrasound or CT scans are other tests that your doctor can request to diagnose hernia.

Types Of Hernia

There are different types of hernias based on their location. The most common types are listed below.

Inguinal
Femoral
Incisional
Umbilical

Inguinal Hernia

Inguinal hernia appears as a bulge in the groin or scrotum, occurring more commonly in men than women. Part of the intestine may protrude through the lower abdominal muscle into the groin

Femoral Hernia

Femoral hernia appears as a bulge in the upper thigh.It may contain a loop of intestine, or another part of the abdomen, that has been forced out of the abdomen through a channel called the "femoral canal"(a tube-shaped passage at the top of the front of the thigh).

This type of hernia tends to occur in older people and is more common in women than in men.

Incisional Hernia

Incisional hernia may be caused by the scar if you have had abdominal surgery. A previous surgical wound can form a structurally weak point allowing a hernia to develop.

Umbilical Hernia

Umbilical hernia is a small bulge around the umbilicus (belly button). Fatty tissue or part of the intestine can protrude through a hole in the abdominal muscle near the belly button forming an umbilical hernia.

Hernia Treatment

A hernia may need to be treated surgically as it may cause

Pain or discomfort
Bowel obstruction
Bowel strangulation which is a serious illness often requiring emergency surgery

HERNIA SURGERY

A hernia repair is usually performed as either day surgery or surgery requiring an overnight stay in the hospital.

The operation may be performed as an

Open Surgery
Keyhole Surgery - laparoscopic

There are two types of laparoscopic surgery these are:

The most commonly used laparoscopic surgical techniques for hernia repair are

Transabdominal preperitoneal (TAPP) and
Totally extraperitoneal (TEP) repair.

OPEN HERNIA SURGERY

About Open Hernia Surgery

Surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated. Surgery aims at closure and repair of the muscle wall through which the hernia protrudes.

Open hernia surgery is generally performed under r general anaesthesia. Your surgeon makes an incision of about 5-10 cm long (depending on the size of the hernia) to view and access the surgical site. Your surgeon pushes the part of the intestine that protrudes back into its normal position and repairs the weakened muscle layer by sewing the edges of the healthy muscle wall together. A synthetic mesh is often placed and sewn over or under the weakened area to provide additional support and strength, by a procedure called hernioplasty. The incision is closed after the procedure using dissolvable stitches.

Post-operative Care

Following surgery, you

Can take a shower only after 24 hours post-surgery
Can go home the day of the procedure or the day after
Should avoid driving while taking pain killers as they induce drowsiness
Can resume daily activities slowly while strenuous activities should be resumed only after consultation with your surgeon
Return to work in about 2 weeks but heavy activities should be avoided for 6 weeks

Risks and Complications

Like most surgical procedures, hernia repair is associated with the following risks and complications:

Reaction to anaesthesia
Infection
Bleeding at operation site
Nerve damage and numbness of skin
Damage to surrounding tissue

Although the recurrence of hernias is not very common, after surgery, you would need to follow preventive measures.

About Laparoscopic hernia surgery

Laparoscopy is especially advised for patients with recurrent hernias, bilateral inguinal herniae and some femoral herniae. However, it is not recommended for patients with very large herniae, strangulated hernia, prior pelvic surgery and intolerance to general anaesthesia. These would typically require an open approach.

Laparoscopic hernia repair is a minimally invasive procedure and as such is associated with less tissue damage and pain and a faster recovery compared to the open approach. This surgical approach allows you to return home the same day and get back to your regular activities sooner.

In our practice, we perform mainly open inguinal hernia surgery. For patients who are deemed suitable for laparoscopic inguinal hernia repair, we refer to specialist hernia surgeons performing high volume laparoscopic surgery.

Laparoscopy is especially advised for patients with recurrent hernias, bilateral inguinal hernias and femoral hernias. However, it is not recommended for patients with very large hernias, strangulated hernias, prior pelvic surgery and intolerance to general anaesthesia. These would typically require an open approach.

Surgical Procedure

Laparoscopic hernia repair is performed under general anaesthesia. Your surgeon will make a few small incisions in your abdomen or groin through which a thin tube called a laparoscope and other special instruments are inserted. A video camera attached to the laparoscope sends magnified images to a monitor guiding your surgeon throughout the procedure. Your surgeon will push the bulge back into the abdomen and either stitch the abdominal wall or use a mesh to support the weakened wall.

Post-Operative Care

Laparoscopic repair of inguinal or femoral hernia is usually performed as an outpatient procedure so you will return home as soon as you recover from anaesthesia. You may have some swelling or bruising at the incision sites which is normal. Pain and swelling are mostly controlled with medications. It is important to avoid strenuous activity or heavy lifting for at least 2 weeks after the procedure.

Advantages & Disadvantages

Risks and Complications

As with any surgery, complications may occur. Complications related to laparoscopic hernia repair include:

Groin pain due to nerve injury
Infection at the incision site or mesh
Blood or fluid accumulation
Urinary retention