Hernia : Frequently asked Questions

Hernia : Frequently asked Questions

In this article, I try to address some of the most frequently asked questions abut Hernia. In a nutshell: Hernia surgery is safe, quick and simple !


What is a hernia ?

A hernia is an abnormal protrusion of an organ or a part of the organ through a normal or an abnormal opening in the wall which contains it. For instance the bowel herniating through the inguinal or femoral orifice in the abdominal wall or bowel herniating through the umbilicus.

 

 

The word hernia is derived from the Latin word meaning bulge and greek word meaning to rupture.

 

How common is hernia? Why does a person suffer from a hernia ?

Hernia is a very common condition occurring in human beings and has been studied from ancient times. Hernias can occur from birth (congenital type) such as the umbilical hernia. Other hernias occur because of pathways formed during fetal development or existing openings in the abdominal cavity, or areas of abdominal wall weakness. Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia later in life, such as :

  • Obesity
  • Heavy lifting
  • Severe prolonged periods of coughing
  • Straining during a bowel movement or urination
  • Chronic lung disease
  • Fluid in the abdominal cavity
  • A family history of hernias can make one more likely to develop a hernia.

 

What are the different types of hernia one can suffer from ?

Based on the location hernias can be identified as:

  • Inguinal hernia – Hernia at the groin, at the junction between the thigh and abdominal wall is one of the commonest types of hernia in the human body.
    • Incomplete hernia – hernia which has not reached the scrotum
    • Complete hernia – hernia that has reached the scrotum
    • Direct hernia – hernia that comes directly forward. This type is more common in aged people irrespective of sex. It is usually bilateral and small. It will usually respond quickly to direct pressure and even just by lying down.
    • Indirect hernia – hernia that passes through inguinal canal are called indirect hernias. It can occur at any age but can be seen only in men and it will be mostly unilateral. When attempting for reduction, it usually goes back into the abdomen by receding upward, backward and laterally.
  • Femoral hernia – This hernia occurs in front of the thigh and is relatively rarer.
  • Umbilical hernia – Hernia at the umbilicus, may be present at birth and may spontaneously close. Women who have gone through multiple pregnancies are liable to suffer from this type of hernia due to weakening of the abdominal wall.
  • Epigastric hernia – This hernia occurs in the upper part of the abdomen above the umbilicus.
  • Incisional hernia occurs through an old incision scar which has broken down or through an old repaired hernial site.

 

How do I know if I have a hernia ?

Hernia may present as a asymptomatic painless lump on the abdominal wall which one can pushed inside by manipulation, in which case it is called a Reducible Hernia. Reducible hernias appear when one stands or strains or coughs and disappears usually on lying down. On the other hand if the lump cannot be pushed inside it is called an Irreducible hernia. If the lump becomes painful and tender to touch and causes various systemic symptoms like vomiting and constipation it is called a strangulated hernia. Herein it is a surgical emergency as the contents of the hernia are strangulated by the defect.

 

What should I do if I have a hernia ?

The presence of a hernia must prompt one to seek a surgical consultation. This is important even if it is a painless lump as it can turn out to a serious problem in the near or late future. If you find a new, painful, tender, and irreducible lump, it’s possible you may have an irreducible hernia, and you should have it checked in an emergency setting. If you already have a hernia and if it suddenly becomes painful, tender, and irreducible, you should go to the emergency department. Strangulation (cut off blood supply) of intestine within the hernia sac can lead to gangrenous (dead) bowel in as little as 6 hours. Not all irreducible hernias are strangulated, but all cases of strangulation are irreducible hernias.

 

When to seek medical treatment ?

Consultation with a surgeon should generally be made so that you can have surgery by choice (called elective surgery) and avoid the risk of emergency surgery should your hernia become irreducible or strangulated.

 

What are the options available for the treatment of hernia ?

Once a surgeon has examined you and has decided about surgery, there are two main options available, Open and Laparoscopic Repair of hernia. The risks and benefits will usually be discussed in detail before one can decide on what type of hernia repair one should undergo. All hernias are now repaired with a prosthetic mesh to prevent a recurrence and give a secure repair. The commonly used materials today are Polypropylene, Polyester, PTFE or a composite mesh(combination of two materials) such as Ultrapro.

 

In open surgery for inguinal hernia for instance surgery is done under local anaesthesia i.e. anaesthesia only at the site of the operation (like a dental extraction), so the patient is able to walk immediately after surgery and can go home in a few hours. There are may innovations in mesh for hernia surgery and the most recent ones are the 3D meshes. However open surgery can also be done under regional anaesthesia such as spinal and epidural anaesthesia or even general anaesthesia. The wound in hernia surgery can be closed with glue avoiding the need for stitches and dressings.

 

In Laparoscopic surgery the hernia operation is usually done through small key holes in the abdomen and the hernia is repaired and a mesh is placed. The laparoscopic repair is usually done under general anaesthesia and may require patient to stay for approximately a day or two.

 

When will a hernia not be operated upon ?

In general, all hernias should be repaired unless severe pre-existing medical conditions make surgery unsafe. The possible exception to this is a hernia with a large opening and a relatively small sac. Trusses and surgical belts or bindings may be helpful in holding back the protrusion of selected hernias when surgery is not possible or delayed. However, they should never be used in the case of femoral hernias.

Avoid activities that increase intra-abdominal pressure (lifting, coughing, or straining) that may cause the hernia to increase in size.

 

What is 3-dimensional mesh in hernia repair ?

A 3D mesh is a pre-shaped three dimensional device constructed of a onlay mesh connected by a mesh cylinder to a circular underlay patch. The mesh is placed with open surgery technique. The underlay mesh layer is placed in the pre-peritoneal plane where mesh is in a deeper plane and the overlay is placed over the muscle layers. This allows the mesh to be secure and does not allow it to be displaced. The 3D mesh is used in inguinal, epigastric, spigelian and umbilical hernia. The 3D mesh has a lower recurrence rate compared to laparoscopic surgery also.

 

What are the types of 3-dimensional meshes that are available ?

3D meshes are available in polypropylene material and composite materials (ultrapro mesh). Ultrapro mesh is a composite material made up of 50 % absorbable material and 50 % non absorbable material. This does not weaken the hernia repair but since half of the mesh is absorbed the comfort level for the patient is enhanced without affecting the safety of the repair.

 

What are the new techniques of fixing a mesh to the muscle and how does it help ?

Since the mesh is a prosthetic material it needs fixing it to the muscle. Conventionally the mesh was fixed to the muscle with sutures, but today we use fibrin glue to fix the mesh to the muscle.

The advantage of the glue is that there will be uniform fixation of the mesh to the muscle instead of point fixation. Secondly, strangulation of a nerve inadvertently will not happen and hence pain will be much less. Further fibrin glue is a biocompatible material and reactions are very rare.

 

Can my hernia wound be closed without stitches ?

Wounds in hernia and other clean surgeries can be closed without sutures. The wounds are closed with cyanoacrylate glues. These are safe and allows the patient to have bath the very next day. Further there is no need for suture or stitch removal and dressings.

 

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