 Hernias
What is a hernia?
A hernia is a “weakness” in the muscles of the abdominal wall that
allows the contents of the abdomen to bulge out. There are a number of
points of weakness in the abdominal wall through which hernias
commonly occur, these are the groin (inguinal and femoral hernias),
around the umbilicus (umbilical and para-umbilical hernias), the upper
abdomen (epigastric hernias), through old surgical scars (incisional
hernias) and around the site of stomas (para-stomal hernias) Patients
often notice a bulge under the skin which may become larger on
standing or lifting and may disappear when laying down. Hernias often
cause discomfort or a dragging sensation and occasionally severe pain.
How does a hernia form?
Hernias may arise in one of two ways firstly they may develop from a
congenital weakness of the abdominal wall present from birth. These
tend to present in childhood or early adulthood. More commonly acquired
hernias occur with ageing when the muscles of the abdominal wall
become less strong.
What is the best treatment for a hernia?
A surgical repair is often the best way to manage a hernia however
this depends on the type of hernia, the symptoms that the patient is
experiencing and the possible risks that performing an operation may
pose to the patient’s general health. In some cases it is perfectly
safe to leave the hernia alone and not do anything to repair it. This
is often the case in older patients whose hernia does not cause them
any noticeable discomfort. Although popular in the past, the use of a
truss for groin hernia, tends to be used less frequently nowadays
since they are generally ineffective at holding the lump inside the
abdomen and are tend to be uncomfortable.
However some cases they work
very well, the same can be said for surgical corsets for other forms
of hernia. Groin hernias in particular may be treated with an
operation under local anaesthetic so that the patient is not put to
sleep at all, allowing even those with patients with breathing and
heart problems to undergo hernia repair. Most hernia repairs are
performed using a synthetic mesh which is stitched or stapled into
place to cover the weakness in the muscles. Although the mesh does not
hold the hernia back in place itself, it allows the body to form scar
tissue which ensures the weakness closes in the vast majority of
cases.
What is a strangulated hernia?
The main risk caused by a hernia is that of strangulation. This occurs
when the neck of the hernia (the weak hole on the abdominal wall
through which the hernia passes) becomes too tight and obstructs the
blood supply to the contents of the hernia. If left untreated this may
lead to perforation of the bowel and spillage of intestinal contents
into the hernia or abdomen. Strangulation may have occurred if the
hernia becomes hard, is difficult to reduce back into the abdomen, if
it suddenly becomes very painful or the patient starts to vomit. If
any of these symptoms occur you should see you doctor immediately.
Some hernias are at more risk of strangulation than others, this is
particularly true for those with a small neck that are difficult to
reduce such as femoral hernias. These hernias should be repaired by an
operation as soon as possible, to reduce the risk of strangulation.
Surgical options for hernia repair
Open hernia surgery
Standard hernia surgery is a tried and tested method which allows many
hernias to be repaired without the need for a general anaesthetic.
With the increasing use of synthetic mesh to re-enforce the hernia
repair recurrence rates have fallen to around 1% for groin hernias and
around 10% for incisional hernias.
Laparoscopic hernia surgery
Laparoscopic (key hole) surgery uses a telescope to look inside the
abdomen. It has become popular method in treating most hernias, with
major benefits seen when used to repair incisional hernias and
recurrent or bilateral inguinal hernias. In these cases the patient
experiences less pain and smaller incisions than the more traditional
open technique and returns to normal activity much faster.
Post operative treatment.
Most hernia repairs are well tolerated by patients and are performed
as a day case without having to stay overnight in hospital. Mild pain
killers may be needed but the majority of patients can return to full
activity within a few days and heavy lifting within a couple of weeks.
Patients are generally allowed to drive when they do not require pain
medication which can make them drowsy and when they feel they would be
safe to perform an emergency stop. Although hernias can recur there
are a number of ways in which this can be reduced such as losing
weight and stopping smoking. Increased weight leads to higher intra
abdominal pressure pushing against the repair and smoking can lead to
a chronic cough also placing increased strain on the hernia repair.
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