Hernia

The abdominal wall is watertight compartment with multiple layers of muscles, which not only protects organs but also has many special functions like spine stabilisation for erect posture, breathing, micturition, defecation. A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. This destabilises multiple compartments. Hernia repair is not just repair of the gap but also reinforcing to stabilise layers to support multiple functions of abdominal wall compartment. Recurrence of hernia after repair can be multiple factors, but most important is not understanding functional components of the abdominal wall.

HERE ARE SOME FAQS ANSWERED!

What is a hernia?

A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias are not immediately life-threatening, but they don’t go away on their own and can require surgery to prevent potentially dangerous complications.

What are the common hernia types?

There are different types of hernia, listed below for easy reference:

Inguinal hernias

Inguinal hernias are the most common type of a hernia. They make up about 70% of all hernias, according to the British Hernia Centre (BHC). These hernias occur when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.

hernia

The inguinal canal is found in your groin. In men, it is the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles. In women, the inguinal canal contains a ligament that helps hold the uterus in place.

This type of a hernia is more common in men than in women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal does not close properly and leaves the weakened area prone to hernias.

Hiatal hernias

A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.

This type of a hernia is most common in patients over 50 years old. If a child has the condition, it’s typically caused by a congenital (birth) defect. Hiatal hernias almost always cause gastroesophageal re-flux, which is when the stomach contents leak backward into the oesophagus, causing a burning sensation.

Umbilical hernias

Umbilical hernias can occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying. An umbilical hernia is the only kind that often goes away on its own, typically by the time the child is 1 year old. If a hernia has not gone away by this point, surgery may be used to correct it.

Incisional hernias

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

Incisional hernia

What are the causes of a hernia?

Usually, there is no obvious cause of a hernia. Sometimes they occur with heavy lifting. Hernias may be present at birth, but the bulging may not be noticeable until later in life. Some patients may have a family history of hernias. Any activity or medical problem that increases pressure on the abdominal wall tissue and muscles may lead to a hernia, including:

  • Chronic constipation, straining to have bowel movements
  • Chronic cough
  • Cystic fibrosis
  • Enlarged prostate, straining to urinate
  • Extra weight
  • Heavy lifting
  • Undescended testicles

What are the symptoms of hernia?

The signs and symptoms of a hernia can range from noticing a painless lump to the painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen. 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 a lump on either side of your pubic bone where your groin and thigh meet. You’re more likely to feel your hernia through touch when you’re standing up. Pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing or lifting. Weakness, pressure, or a feeling of heaviness in the abdomen a burning, gurgling, or aching sensation at the site of the bulge.

In the case of an inguinal hernia

In case of hiatal hernia, acid reflux is one of the symptoms, which happens when stomach acid moves backward into the oesophagus causing a burning sensation, chest pain, and difficulty in swallowing.

In case of anterior abdominal wall or incision hernia – mild discomfort in the abdominal area, pain in the abdomen outward bulging of skin or tissues in the abdominal area, nausea, and vomiting are common symptoms.

How do you diagnose a hernia?

A doctor can confirm the presence of a hernia during a physical examination. The mass may increase in size when coughing, bending, lifting, or straining. A hernia (bulge) may not be obvious in infants and children, except when the child is crying or coughing.

Radiological modalities used are:

  • Ultrasound of the abdomen area of interest
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)

How do you treat a hernia?

Whether or not you need treatment depends on the size of your hernia and the severity of your symptoms. Your doctor may simply monitor your hernia for possible complications. Treatment options for a hernia include:

Lifestyle changes

Dietary changes can often treat the symptoms of a hiatal hernia. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range. If these changes in diet don’t eliminate your discomfort, you may need surgery to correct the hernia. You can also improve symptoms by avoiding foods that cause acid reflux or heartburn, such as spicy foods and tomato-based foods. Additionally, you can avoid reflux by losing weight and giving up cigarettes.

Medication

If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.

Surgery

If your hernia is growing larger or causing pain, your doctor may decide that it’s best to operate. Options for surgical treatment include:

  • Mesh placement surgery:A surgeon pushes tissue back into place and then sews in a wire mesh (like a reinforcing patch) to keep it in place. This is considered safe and reliable.

  • Laparoscopic removal: A surgeon makes multiple small openings and fixes a hernia using a small camera inside the body to direct the surgery.

  • Open surgery (non-laparoscopic). A surgeon makes a large opening and enters the body to push the tissue back into place and then sew it.

What are the benefits of laparoscopic removal?

The benefits include:

  • Much smaller cut site (lowers chance of infection)
  • Reduced postoperative pain
  • Reduced hospital stay (generally able to leave day of or day after procedure)
  • Absence of large scar
  • Faster overall recovery time

What are some of the concerns of open surgery?

Some of the concerns include:

  • Longer stay in the hospital after surgery
  • Greater amount of pain
  • Medium to large scarring

Hernia as a day care surgery- what are the facts around this?

Laparoscopic hernia repair is rapidly gaining popularity in the West and in India. This technique is preferred over the earlier one for the following reasons:

The open approach to hernia repair involved a cut over the hernia, reduction of the contents back to the tummy and some form of stitching of the defect to prevent the hernia from coming back.

All open surgical techniques involve cutting of the muscles overlying the hernia in order to be able to reach the defect. This in effect weakens already weak muscle tissue, and like any other way of hernia repair, means rest after the operation.

The main problem with the open technique of hernia operation is the average six weeks of rest after surgery and the chance of a hernia coming back.

Advantages of laparoscopic surgery for hernia repair

  • Laparoscopic surgery causes less pain and patient can move within few hours after surgery
  • After laparoscopic surgery patient can resume the daily activities within 5-7 days
  • The cosmetic results for laparoscopic surgery are excellent as compared to the conventional surgery
  • In patients of recurrent hernias, where the anatomy has already been disturbed, and also in patients of hernias on both sides, they can be repaired through the same three holes avoiding any further pain or trauma.

How can you prevent a hernia?

You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse.

Prevention Tips

  • Avoid smoking
  • See your doctor when you’re sick, to avoid developing a persistent cough
  • Maintain a healthy body weight
  • Avoid straining during bowel movements or urination
  • Lift objects with your knees and not your back
  • Avoid lifting weights that are too heavy for you

Dr. Nanda Rajaneesh has over 18 years of experience in surgical oncology and laparoscopic surgery. She is currently a visiting consultant in both Apollo Spectra Hospitals and Sakra World Hospital. She has operated many film stars & VIPS, both at regional and national level.