Hernia: What it is, symptoms, types, causes & treatment

What is Hernia?

Hernia is a condition in which part of an organ is protruded out through the wall of the cavity containing it (often involving the intestine at a weak point in the abdominal wall forming a lump below the skin).

What are the different types of Hernia?

Hernias can be seen in Groin, above umbilicus, below umbilicus, or at umbilicus and at the site of previous surgical scars. They can be named accordingly.

• Epigastric – Above Umbilicus

• Umbilical

• Inguinal - Groin

• Incisional – Surgical Scar

• Femoral

• Lumbar

• Spigelian

• Hiatus Hernia

• Diaphragmatic Hernia

Inguinal Hernia is the most common type and it is found in Groin. This type is more common in men than women

What is Hiatus Hernia?

It is a condition in which part of the stomach protrudes up through the diaphragm into the chest cavity.

Why does anyone can develop hernia?

Inguinal hernias are considered to have both a congenital and acquired component of origin. During normal development, the testes descend from the abdomen into the scrotum leaving behind a diverticulum called process usvaginalis. In normal development, the process usvaginalis closes but failure of this closure can lead to an indirect inguinal hernia.

Most adult inguinal hernias are considered acquired like increased intra-abdominal pressure, as seen in obesity, chronic cough, heavy lifting, and straining due to constipation.

Incisional hernias develop because of the failure of the abdominal wall to close properly.

Reasons for failure to close properly include: patients related factors, disease-related factors, and technical factors.

Patient-related factors that impair proper wound healing - Diabetes, Renal failure, Obesity, Smoking, and Malnutrition or systemic long term medications like Steroids and Immunosuppressants.

Disease-related factors including incision site, timing, and urgency of procedure, complications, and the underlying disease play an important role in the occurrence of incisional hernia.

What are the symptoms?

Hernias can present with an array of different symptoms. Most patients present with a bulge or pain that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation. These sensations can radiate into the scrotum or down the leg if it is Inguinal Hernia. They can present with severe pain or obstructive symptoms caused by incarceration or strangulation. In Case of hiatus hernia patient can have heart burn and gastroesophageal reflux episodes.

How to diagnose?

Physical examination is the best way to diagnose a hernia. If a hernia is present, the doctor will be able to palpate a bulge that moves in and out as the patient increases intraabdominal pressure through coughing or Valsalva. Examination of the opposite side is essential as this allows the clinician to compare right versus left for symmetry and/or abnormalities.

A radiologic investigation like ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI)may be warranted to confirm the diagnosis. Endoscopy is recommended for diagnosing hiatus hernia.

Is the treatment recommended for all Hernias?

Hernias do not go away on their own. Treatment is recommended for all symptomatic hernias to avoid complications.

What is the definitive treatment for Hernia?

Surgical repair is the definitive treatment for hernia. An open or laparoscopic approach can be used with the goal of defect closure and a tension-free repair. A mesh is usually used for a tension-free repair like polypropelene, Biological, Lightweighted or 3D meshes. Type of repair will be decided depending on the type and location of hernia. Hiatus hernia can be repaired without mesh adding an anti-reflux procedure.

Any advanced treatment is available for Hernia?

Yes. Nowadays almost all hernias are approached with minimally invasive (key Hole) techniques. Both Laparoscopy and Robotic surgeries are available. Laparoscopically various surgeries like IPOM, IPOM Plus, TAPP, TEP, e-TEP, SCOLA are available depending on the type of hernia. At our hospital we prefer to operate most of the patients by minimal invasive method.

What are the advantages of minimally invasive techniques?

Minimally invasive technique repairs compared to open repairs have less recurrence rates, improved postoperative pain and patients may resume normal activities sooner.

What is the prevention?

Healthy dietary habits, life style modifications, regular physical activity, avoiding smoking and alcohol, maintaining adequate body weight, avoid lifting heavy weights and avoiding straining on passing stools.

(Ph: 04023785678 / 77992 35678, Toll Free No. 18005992020, email id [email protected]. www.slghospitals.com.)