Hernia

What is hernia? 

A hernia occurs when part of your insides pushes through an weakness in the muscle or tissue barrier that contains it. It often appears like a swelling that comes and goes during strenuous activities.

Common types of hernia 

Incisional hernia - is a hernia that occurs through a former abdominal surgical incision. Surgery in the abdomen requires suture closure of the cut. Sometimes the wound does not heal properly and a weakness can develop subsequent to this. Factors that may increase the likelihood of an incisional hernia include systemic chronic diseases such as diabetes, chronic kidney failure, obesity, smoking, malnutrition, and immunosuppressants e.g. steroids, chemotherapy, etc. 

Inguinal hernia - Inguinal hernia is the most common type of hernia amongst all hernias (~75%). This hernia typically occurs through the lower abdominal wall. 

Femoral hernia - Femoral hernia on the other hand is less common. Fatty tissue or bowel may protrude into the groin at the top of your inner thigh, through the femoral canal. 

Ventral (epigastric, umbilical) - Ventral hernias are hernias that occur along the front midline of your abdomen. Specifically, epigastric hernia occurs above the belly button. Umbilical hernia occurs at an opening either at or near your belly button.

Rare types of hernias 

Perineal hernia - Perineal hernia is rare and it occurs when organ pushes through a weakness in your pelvic floor. This hernia can be a rare complication of pelvic surgery. It can also develop after an illness or traumatic injury. 

Spigelian hernia - Spigelian hernia occurs through slit like defects in the abdominal wall, at the outer edge of the rectus muscle; also known as your “six-pack”. The diagnosis of Spigelian hernia is difficult as there may not be an obvious bulge. A history of pain at this location during cough, strain and lifting may be indicative of a possible Spigelian hernia.  

Lumbar hernia - Lumbar hernia is a protrusion through the lumbar triangle. These hernia typically presents with lower back pain on coughing and straining and may be associated with lower limb neurology or a tender bulge in the back. 

Causes of hernia 

Hernias are usually caused by a combination of pressure pushing an organ or tissue through a weak spot in the muscle or fascia. Sometimes the weak spot is present at birth. However, more often it can occur gradually later in life after trauma, or surgery.

Symptoms of hernia 

Visible lump is one of the key characteristics of a hernia. The bulge may be more obvious when you are upright, coughing, straining or heavy lifting. This applies to all hernias except for Spigelian hernia which could be difficult to detect without the help of scans. 

How serious is a hernia?

Most hernias aren’t serious, but they can be. If left untreated, the hernia may increase in size over time. Contents such as small or large bowel, may get stuck outside of the weak spot and can’t go back in. The swelling will become increasingly painful as the blood supply gets cut off. Finally, resulting in tissue death and perforation (if its a hollow viscus).

How are hernias treated?

• A consultation with your GP and subsequent referral to a general surgeon will ensure that your symptoms are appropriately assessed and treated 

• Conservative measures - this means living with the hernia, making lifestyle changes and monitoring the size and symptoms of the hernia. It usually involves weight loss, avoiding strain and heavy lifting, wearing of a hernia belt, and treating chronic disease e.g. obstructive uropathy, chronic cough and chronic constipation. On one hand, patients who have little or no discomfort from their hernias in general have low rate of complications, such that surgery is not immediately necessary. However, it is still important to see a surgeon to discuss the best treatment options for you as the natural progression of over 80% of hernias is to become larger and more painful over time.

• Surgical management options - hernia can be repaired using an open or laparoscopic approach, with or without the usage of mesh. The different types of mesh may include: synthetic, biologic or biosynthetic meshes. Its usually performed under general anaesthetic (GA) but smaller hernias or inguinal hernias may be performed under regional blocks in elderly group of patients who may not be fit for GA. 

Who should perform my surgery?

Many general surgeons perform a high number of hernia surgeries per year and have outstanding outcomes. 

What to expect after hernia surgery?

Majority of the patients successfully manage their post operative pain with simple analgesia alone. Its important to avoid heavy lifting for 6 to 8 weeks to allow tissue healing. Its important to avoid smoking. Almost everyone is back doing non-strenuous activities baby 2 weeks post surgery.