Do I Have Hernia? if So, What Should I Do?

HERNIA

WHAT IS HERNIA?

It is a weakened spot through which contents of abdomen come out to lay just below the skin. Usually there are layers of muscle and sheath covering the intestine before skin and when weakness happens for one or the other reason discussed later in the blog then people develop hernia. 

TYPES OF HERNIA

Incisional hernia

This happens at the site of previous surgery. This type of hernia is because of incomplete healing at the time of previous surgery or as a result of complication of previous surgery like infection. It has to be noted that 5-10% of all patients who had undergone surgery develop this. This is very rare after Laparoscopic or keyhole surgery.

Umbilical and paraumbilical hernias

Both of these hernia happen around already existing weak spot in abdomen that being umbilicus.

Umbilical hernia can be present at the time of birth and there is no need to repair them unless they are big. Usually most of the umbilical hernia resolve by end one one year. If present beyond 5 years, then repair is needed.

Paraumbilical hernias are acquired hernia which develop above the umbilicus. 

Epigastric Hernia: 

These are hernias appearing in the midline above the umbilicus upto chest bone.

Inguinal and femoral Hernias:

Inguinal hernias are the most common hernias. They are more common in men than woman.

Femoral hernias appear in groin below where inguinal hernia appear. They are more common in elderly females.

Who gets hernias?

People who have conditions that lead to increased abdominal pressure are at more risk of developing hernias. Some of them are

[if !supportLists]·Persistent coughing

[if !supportLists]·Being overweight or pregnant

[if !supportLists]·Lifting, carrying or pushing heavy loads

[if !supportLists]·Straining on the toilet

What are the symptoms?

Most times they are asymptomatic (no symptoms). People might just notice swelling. The swelling tends to get bigger while standing or doing work and disappear while sleeping. Some might feel dragging/aching sensation. The swelling tends to get bigger with time.

Symptoms develop when there is a complication like strangulation. This happens when the contents of abdomen (intestine) come out and can not go back. When this happens there will be severe pain in the region and vomiting  with hard irreducible swelling. Skin might get red. When this happens you would need surgery within 24 hours to save the stuck intestine, otherwise the blood supply to part of intestine outside abdomen might get cut off and it might dye (gangrene,  requiring resection of that part of intestine.

How are hernias repaired?

Now a days, most of the hernia are repaired laparoscopically. This means you are in the hospital for only 24 hours. Each type of hernia repair is different and depends on many factors like site of hernia, size of defect, associated medical conditions, type of hernia, affordability of patients andskill of surgeon.

In general Laparoscopic hernia repair is costlier as mesh used needs one side which is contact with intestine to be covered with special layer which makes sure intestines do not stick to the mesh. Then we need tackers (Screws) to fix the mesh. In addition cost of laparoscopic instruments tends to be more that open. 

Laparoscopic repair has clear advantage over open repair in the way of less pain, small scars, early return to work and daily activities. Laparoscopic repair is also associated with less recurrence.

Complications:

About 2% of hernias being operated for the first time come back worldwide. (Even if your surgeon does not tell this -- it is a fact. I often tell the day when one can do hernia repair without recurrence he will get nobel price). 

Very rarely intestinal injury. This is more likely in the incisional hernia or recurrent hernia. 

                                                 
                                                 By

Dr. Maruthesh Gowda

MBBS , FRCS - Laproscopic Surgery , M.R.C.S-General Surgery