A hernia occurs when an internal part of the body protrudes through a weakening (defect) in the tissue surrounding it. The garden-variety hernias that occur in our patients generally result from a weakening in the musculature around our abdomen leading to protrusion of internal viscera such as intestine, omental fat or bladder.
Hernias are generally classified by the anatomical location at which it occurs. The most common area for hernias to occur is around the groin (inguinal hernia) or front lower part of the abdomen. Hernia can also appear in the upper thigh and groin areas. Examples are:
Another common anatomical location is around the front part of the abdomen. Examples are:
Most hernias have no apparent cause. Some people may be predisposed towards developing hernias. Some of these factors and symptoms include:
Ventral or incisional hernia deserves a special mention as it usually occurs over an area of weakness resulting from a previous surgical scar.
Generally, a localized pain or discomfort is felt intermittently around the hernia. This is due to the internal viscera ‘sliding’ in and out of the defect. Small hernias can progress and evolve into large hernias with increasing symptoms. Severe symptoms occur when the internal viscera that protrudes through remains stuck and unable to return to its original position. If a loop of intestine is entrapped, you may experience nausea, vomiting, constipation or abdominal distension. If medical attention is not sought quickly, that loop of bowel loses its blood supply and becomes gangrenous (dead). Such a situation is life-threatening. Unfortunately, this is not an infrequent situation amongst some patients who have neglected a long-standing hernia.
The most common symptom of a hernia is a bulge or lump in the affected area. In the case of an inguinal hernia, you may notice the hernia bump on either side of your pubic bone. You're more likely to feel your hernia through touch when you're standing up or bending down.
Some types of hernia, like hiatal hernia, can have more specific symptoms like heartburn and chest pain.
Surgery is the only effective hernia treatment. Ideally, surgery should be performed while the hernia is small resulting in minimal symptoms. The principle of a hernia repair is to ‘seal’ the defect with a prosthetic material known as a mesh. By anchoring a mesh over the defect, the mesh material assimilates with the normal bodily tissue over time thereby ‘sealing’ and strengthening the musculature. Hernia repair may be performed by open (traditional) or laparoscopic (keyhole) approaches. Both approaches are equally effective. However, the advantages of a laparoscopic repair are:
Hernia surgeries fall into three main types: open hernia repair, laparoscopic (minimally invasive) repair, and robotic repair.
In open hernia repair surgery, the surgeon makes a single incision (around 6 to 8cm in length) close to the site of the hernia. The herniated tissue is then pushed back into the abdomen. A mesh will then be inserted in the abdominal wall in order to strengthen it while it heals. Your skin will be stitched together using bioabsorbable threads that dissolve naturally over the course of a few days.
This procedure is usually performed under regional or general anaesthesia. Rarely, it can be done under local anaesthesia especially when there are concerns with general anaesthesia risk.
In laparoscopic hernia surgery, several small incisions are used instead of one larger incision. Surgical gas is used to expand the space in which the surgeon operates. A mini scope called a laparoscope is then inserted through the tiny incision so that the surgeon can examine the groin for defects. Fewer stitches are needed for this surgery and surgical tape is usually used to seal the incision site. This procedure is performed under general anesthesia.
Robotic repair surgery is a relatively newer surgical technique for hernia repair. It is similar to laparoscopic hernia surgery as the surgeon uses tiny incisions and a laparoscope in order to examine in the abdomen and groin. In robotic repair surgery, however, the surgeon is seated at a console in the operating theatre and operates the medical equipment from the console. This surgical technique has the advantage of maneuverability within a tight operative space as well as providing 3D images compared to the 2D images of a conventional laparoscopic surgery.
After the hernia repair surgery is complete, you may experience some pain around the surgical site which can be managed with a course of pain medication. Recovery after a hernia repair surgery is usually around 1-2 weeks. You should avoid any forms of strenuous activity that might aggravate the wound for at least 4 weeks post-surgery.
Most patients report feeling a lesser degree of pain after a laparoscopic hernia surgery or robotic repair surgery as compared to an open hernia surgery.
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