Hernia can be fixed by a small operation

A hernia is a lump which occurs from a weakness in the wall of the abdomen. Most hernias need treating by performing an operation. There are now various different types of operation which can be performed to repair hernias. They are usually very successful.

What is a hernia?

A hernia (or "rupture") occurs where there is a weakness in the wall of the abdomen. As a result, some of the contents within the abdomen can then bulge (push through) under the skin. Normally, the front of the abdomen has several layers comprising skin, then fat, then muscles, which all keep the intestines (guts) and internal tissues in place. If, for any reason, there is a weak point in the muscles, then part of the intestines can push through. You can then feel a soft lump or swelling under the skin.

What are the types of hernia?

Different types of hernia can occur. The most common types are listed here:

Inguinal hernia

This occurs when some tissue pushes through the lower abdomen in the groin. This is the most common type of hernia, accounting for more than three out of every four hernias. They usually occur in men. They can occur in both sides of the body. These hernias often occur after heavy lifting, during which you may experience a sharp pain in the groin and notice the appearance of a swelling.

Femoral hernia

This also occurs when some tissue pushes through in the groin, a little lower down than where an inguinal hernia occurs. They occur more commonly in women. They tend to be smaller than inguinal hernias.

Incisional hernia

This occurs when tissue pushes through a previous scar or wound. They are more common if you have had a scar in the past that has not healed well. For example, if the wound had an infection after the operation. They usually occur within two years of having an operation.

Umbilical and paraumbilical hernias

These occur when some tissue pushes through the abdomen near to the umbilicus (belly button). Umbilical hernias are present from birth and, if they need treatment, then they are usually repaired in childhood. In most cases of umbilical hernia, the hernia goes back in and the muscles re-seal on their own before the baby is one year old. Paraumbilical hernias occur in adults and appear above the umbilicus. Although they are usually small, they usually need repairing because there is a risk of intestines contained within them becoming strangulated.

Who gets hernias?

Hernias can occur in anyone. Men are more likely to have inguinal hernias, as they have a small tunnel in the tissues of their groins which occurred when they were developing as a baby. This tunnel allowed the testes to come down from the abdomen into the scrotum. Intestinal tissue can also pass into this tunnel, forming an inguinal hernia.

Hernias in adults may arise as a result of the strain which raises the pressure in the abdomen causing a weakness or tear in the abdominal wall. This can be caused by:

• Persistent coughing.

• Being overweight or pregnant.

• Lifting, carrying or pushing heavy loads.

• Straining on the toilet.

What are the symptoms?

Sometimes a hernia is noticed after a strain - for example, after lifting a heavy object. Sometimes one may develop for no good reason and you may simply notice a small lump that has develop, usually in the groin area. Usually, at first, the lump can be pushed back, but may pop out after straining again. Coughing is a common strain that brings them out.

The swelling often disappears when you lie down. Hernias are not usually painful, but many people feel an ache over a hernia which worsens after doing any activity. In time, they might become bigger as the gap in their muscle or ligament tissue becomes larger. Sometimes, in men, they track down into the scrotum.

Why do they need treatment?

Although having a hernia is not usually a serious condition, treatment to fix it is usually advised for two reasons:

• It may gradually become bigger and more uncomfortable.

• There is a small chance it might strangulate. A hernia strangulates when too much intestine (bowel) has come through the gap in the muscle or ligament and then it becomes squeezed.

This can cut off the blood supply to the portion of intestine in the hernia. This can lead to severe pain and some damage to the part of the intestines in the hernia. A strangulated hernia is usually dealt with by emergency surgery. However, it is preferable to have the hernia fixed by routine rather than by emergency surgery.

How are hernias repaired?

A hernia can be fixed by a small operation. Wearing a truss (support) was used in the past but is now not recommended.

A hernia repair is one of the most common operations performed by surgeons.

There are few options available for a patient who has a hernia.

• Most hernias require a surgical procedure.

• Surgical procedures are done in one of two fashions.

i. The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually performed using a spinal anesthetic.

ii. The laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.

Three quarter inch incisions are usually necessary. The hernia is repaired and a small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples. This operation is performed with general anesthesia.

What are the advantages of laparoscopic hernia repair?

Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). It offers a quicker return to work and normal activities with a decreased pain.

What should I expect after surgery?

With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.

What can be done to prevent an abdominal hernia?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime.

Are abdominal hernias inherited?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem.

Should all abdominal hernias be repaired?

In general, all hernias should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.