|
A hernia is a protrusion of an internal organ through a weakness in the muscle or tissue that holds it in place. Most hernias occur in the abdominal wall. While most hernias are not life-threatening or cause immediate distress, they can be bothersome and the only means of treatment is surgery. However, if a hernia is not treated, the content can be trapped in the hernia causing severe pain. If the hernia is not reduced this can lead to dead bowel in the hernia which is life-threatening.
|
|
Many types of hernia have been described but the commonest are inguinal (groin), femoral (thigh), umbilical, hiatal and incisional hernias. Patients with inguinal hernias complain of a bulge or heavy dragging sensation in the groin which is relieved by sitting or lying down. Femoral hernias have similar symptoms to inguinal hernias. Umbilical and incisional hernias present as protruding bulges around the umbilicus or surgical wounds. Hiatal hernias often present with symptoms of gastric reflux.
|
|
Inguinal hernias are the commonest and occur more frequently in men. The inguinal canal is an area in the groin which connects the testes to the prostate via the spermatic cord. To allow passage of the spermatic cord and blood vessels to the testes, there is a natural opening in the muscles of the groin and this area is weaker than the surrounding muscles. Increased pressure in the abdomen leads to protrusion of fat or bowel loops into the groin causing a hernia. In women, there is a ligament in place of the spermatic cord and therefore, the weakness is less obvious.
|
|
Femoral hernias occur due to a weakness of the tissues surrounding the blood vessels going into the thigh just under the groin creases. Sometimes, they are mistaken for inguinal hernias as they have similar symptoms.
|
|
Umbilical hernias are protrusions in the umbilicus and commonly contain a layer of fat cells only. These are not the same as everted umbilicus during pregnancy as those will recover spontaneously. Incisional hernias occur at the wound/ scar of previous abdominal surgery.
|
|
Hiatal hernias occur due to part of the stomach bulging though a weakness in the diaphragm into the chest cavity. These patients often have gastric reflux with burning chest discomfort. The surgery for hiatal hernia requires specialized skills related to stomach surgery and are best performed by specialist gastric surgeons.
|
|
Most hernias are easily diagnosed on clinical examination. In some cases of early small inguinal or femoral hernias, an ultrasound of the groin can help confirm the diagnosis. Importantly, we need to identify and correct risk factors for development of hernias.
|
|
The more common risk factors are:
|
- Obesity and sudden weight gain
- Constipation or obstructed defaecation syndrome
- Enlarged prostate/ benign prostatic hyperplasia
- Chronic cough
- Weight lifting/ training
|
|
Surgery is required to correct the hernia and almost always require inserting a plastic mesh into the weakness. This is necessary as older forms of repair by bringing the surrounding muscle and tissue together leads to a very high rate of recurrence. Plastic meshes have also been shown to be very safe without infection or pain. The recurrence rate is less than 1% when performed well.
|
|
Most operations for inguinal, femoral or umbilical hernia can be performed as day surgery operations with patients returning home the same day. In more complex cases, these patients may need to stay overnight in hospital after surgery for closer monitoring.
|
|
Inguinal hernias can be treated by open or keyhole (laparoscopic) methods. Both methods offer very good results (less than 1% recurrence rate) and extremely low risk of complications (less than 1% infection or post-operative pain). The difference is that the keyhole methods offers faster recovery but costs more. Femoral hernias are treated similar to inguinal hernias. Umbilical hernias are repaired via an open approach next to the umbilicus.
|
- Open Inguinal Herniorrhaphy
The open method of inguinal hernia repair is performed via a small incision in the groin. A mesh in placed in the area of weakness after the hernia is reduced and the patient takes antibiotics for a week. Most patients return to full activity after 2 weeks.
- TEP (totally extra-peritoneal) Laparoscopic Herniorrhaphy
This method is performed under the muscles of the abdomen but do not enter the abdominal cavity. This form of surgery offers very fast recovery and most patients return to full activity within a week.
- TAPP (trans-abdominal pre-peritoneal) Laparoscopic Herniorraphy
This method is performed using keyhole instruments in the abdomen but the mesh is placed in s similar manner to the TEP method. Recovery is similar to the TEP method but there is a risk of adhesions of small bowel to the wounds.
|
|
There is no special dietary restrictions after the surgery. All patients are advised not to take part in physical exercise or lift heavy weights for the first 2 weeks or until the wound heals.
|
