What is a hernia?
A hernia means something coming through. It most frequently occurs when an organ or internal tissue pokes through a hole or weakness in your abdominal muscle wall.
In many cases, people have no or very few hernia symptoms. You may notice a swelling or lump in your stomach area or groin. Often you have no hernia pain.
If your hernia causes sudden pain and especially if it can’t be pushed back in, you should seek urgent medical care. It may mean that your hernia is trapped or tightly pinched where it pokes through the muscle wall (obstruction) and in extreme cases it may cut off the blood supply to your intestines and tissues in your abdomen (strangulation).
A hernia is not usually a serious condition but it will not go away without hernia treatment known as a hernia repair.
What does the hernia surgery involve?
Hernia repair surgery is the world’s most common surgical procedure. Hernia surgery can help to relieve pain, return the hernia abdominal organs to their correct place and, strengthen the weak muscle area.
A hernia operation usually takes around an hour as a day case procedure. It can be performed by:
• Open surgery – under local or general anaesthetic, an incision usually around 2.5 to 3 inches is made to your skin near your hernia and your surgeon will push your hernia back into your abdomen. The incision is then either stitched closed or much more commonly a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.
• Keyhole (laparoscopic) surgery – under general anaesthetic, several smaller incisions are made to allow your surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair your hernia. A mesh may then be used to strengthen your abdominal wall.
If hernia surgery is recommended, your surgeon will advise on the most appropriate type of surgery based on the location and severity of your hernia.
Are there different types of hernia?
Most hernias are found in the abdomen. Areas of weakness in the abdominal wall where hernias are commonly found include the groin, upper stomach, belly button and, where you have a surgical scar.
The most frequently seen types of hernia include:
• Inguinal hernias – the most common hernia, seen more in men, causes a bulge in your groin. The inguinal hernia appears through your inguinal canal, a narrow passage that blood vessels pass through in your abdominal wall and, may reach your scrotum.
• Femoral hernias – also a bulge in your groin, relatively uncommon and seen more in women. The femoral hernia happens at the hole in your abdominal wall where the femoral artery and vein pass from the abdomen into your leg.
• Hiatus hernias - occur in your upper chest area when part of your stomach pushes up into your chest by squeezing through a gap in your diaphragm called the hiatus.
• Umbilical/periumbilical hernias – occur at the umbilicus, a natural weakness in your abdominal wall, when fatty tissue or a part of your bowel pokes through your abdomen near your naval.
• Incisional hernia – occurs through a scar from past abdominal surgery as tissue pokes through the weak healed site in your abdominal wall.
What complication can happen after the hernia surgery?
Hernia surgery is a routine procedure, but as with all surgeries there are risks of complications. These may vary depending upon the exact hernia operation you have and your health. Your surgeon will discuss these with you in detail.
Often the greatest complication risk is a reoccurrence of the hernia. Other hernia surgery side effects include: build-up of seroma or a fluid-filled sac under the surface of the skin, inability or difficulty urinating, organ or tissue damage, wound infection and, rejection of the mesh.
How soon will I recover after the hernia surgery?
Recovery time after hernia surgery is usually two to three weeks. Most patients will return to normal daily activities and go back to work within a week. You should not do any heavy lifting for at least six weeks. Your surgeon will talk to you about what you can and cannot do for your specific hernia operation.
And Also:
ABOUT YOUR HERNIA SURGERY
Hernia repair has been around for a long time. That means traditional techniques have been perfected while new options and materials have been developed. While not every technique is right for every hernia, they all have common goals: to provide the strongest repair and least chance of recurrence with the least possible discomfort and quickest recovery.
OPEN TENSION REPAIR
Until about 25 years ago, hernias were repaired one way, referred to as ‘open tension’ repair. Here’s what that means:
Open — An incision of 3" to 6" is made in the abdomen to give the surgeon access to the hernia.
Tension — The edges of healthy tissue around the hernia are pulled together and sewn with sutures.
The incision is then closed with dissolving sutures or abdominal adhesive.
This method has been tried and true for decades and may be the only way to repair a very large hernia. The incision tends to be painful and recovery can take as long as five to six weeks. The incision also leaves a scar, although it’s usually very low on the abdomen. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.
THE BEST REASON TO FIX YOUR HERNIA EARLY!
Today’s hernia repair options include new techniques and materials that can make surgery less invasive, recovery faster, and recurrence less likely. And the smaller your hernia (meaning the earlier you fix it), the more options you’re likely to have.
NON-TENSION OR MESH REPAIR
Non-tension means just that. Instead of pulling the tissue around the hernia together, a piece of mesh is positioned to reinforce the area and fixed in place with sutures and/or staples.
The mesh is made of a flexible material that stays in the abdomen and encourages new tissue to grow into it.
Mesh repair has a lower incidence of recurrence than tension repair. There are also different kinds of mesh, including patches, plugs, three-dimensional, expanding, self-absorbing, and even self-gripping mesh that requires few to no sutures to keep it in place. A surgeon who specializes in hernia repair is most likely to have experience using the latest procedures. Ask which ones he or she uses, which may be best for you, and why. Sometimes the best procedure for you is the one with which your surgeon has the most experience and is most comfortable. Don’t hesitate to ask!
LAPAROSCOPIC OR CLOSED REPAIR
Many inguinal hernias can be repaired using a ‘closed’ or laparoscopic procedure — especially when they’re smaller. Laparoscopic repair entails inserting special instruments through tiny incisions in the abdomen through which the surgeon is able to visualize and perform the procedure. Laparoscopic repair uses mesh for reinforcement, so it has a lower recurrence rate. Plus, a smaller incision means less discomfort after surgery, little to no scarring, and a quicker return to normal activity. Many people return to work within a few days.
HOW IT WORKS
Your surgeon makes three or four ¼" to ½" incisions in your abdomen. One is near your navel and the others lower down.
A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualize the area on a TV monitor.
The surgeon performs the procedure using tiny surgical instruments inserted through the other openings while viewing it on the TV monitor. The mesh is positioned and fastened in place with sutures and/or staples.
The instruments are removed and the holes are closed with a stitch or two or with surgical tape.
ANESTHESIA
While open hernia repair may be done under general, regional (spinal), or even local anesthesia with sedation, laparoscopic hernia repair is always done under general anesthesia. If the idea of general anesthesia makes you nervous, it shouldn’t. General anesthesia is extraordinarily safe with today’s precise administration and monitoring. Your anesthesiologist is present throughout your surgery and monitors you continuously. When your procedure is finished and the anesthesia is stopped, you’ll wake up very quickly.
And if you’re concerned about side effects from general anesthesia, such as nausea and vomiting or headaches, you should know these are rare — the exception rather than the rule. Even if you’re having open repair, your surgeon may prefer to perform the surgery with general anesthesia. It may be easier and more comfortable for you, too. After all, what’s easier than going to sleep, waking up and…it’s done?
BEFORE YOUR SURGERY
A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram), and a chest X-ray to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen (Advil), which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill it before your surgery, so you don’t have to think about it after.
THE DAY OF SURGERY
You’ll arrive at the hospital the morning of your surgery; you’ll sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.
The anesthesiologist will meet with you and review the type of anesthesia you and your surgeon have decided on. You’ll be given medication to relax you.
Next you’ll be taken to the operating room, your anesthesia will be administered and the next thing you know…
THAT’S IT — YOU’RE DONE.
You’ll be waking up in the recovery room with your surgery behind you. Sound easier than dealing with your hernia? It is. Now you can concentrate on your recovery and getting back to your life.
And Also:
ABDOMINAL HERNIA FACTS
Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.
There are many different types of hernias.
Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage or death of the tissue.
Hernia repair and the treatment of hernia complications require surgery.
Lumps and swelling in the abdominal area should be examined by a doctor.
WHAT IS AN ABDOMINAL HERNIA?
A hernia is a general term that refers to a bulge or protrusion of a body tissue or organ through the structure that normally contains it. For example, brain tissue can herniate as can discs in the spine. A common herniation in people is an abdominal herniation.
An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to urinate or have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.
When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs). Serious complications from a hernia can result from the trapping of tissues in the hernia -- a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.
About 10% of the population will have an abdominal hernia during their lifetime. The hernias may occur in infants, children, and adults -- both in males and females. However, the majority of abdominal hernias occur in males.
WHERE ARE ABDOMINAL HERNIAS LOCATED?
The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force that pushes toward the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues, enlarging any preexisting hole, or leads to a tear, resulting in a new hole.
Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). Hernias can also occur within the navel (umbilical hernia).
WHAT ARE ABDOMINAL HERNIA SYMPTOMS AND SIGNS?
Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area. A hernia can also be painless and only appear as a bulging. The pain may be intermittent or constant and the swelling may decrease or be absent, depending on the amount of pressure in the abdomen. Constant, intense pain at a bulge site may indicate a medical emergency and should be evaluated immediately by a doctor.
WHAT ARE THE DIFFERENT TYPES OF ABDOMINAL HERNIAS?
Epigastric, umbilical, incisional, lumbar, internal, inguinal, hiatal, and Spigelian hernias all occur at different sites of the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.
HOW IS AN ABDOMINAL HERNIA REPAIRED AND TREATED?
A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In the open surgical approach, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the possible complications of this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.
In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. Hernia repair with mesh has proved to be a very effective means of repair.
After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques.
WHAT IS LAPAROSCOPIC ABDOMINAL HERNIA REPAIR SURGERY?
A number of factors have led to the development of a new method of repair called laparoscopic hernia repair. This technique is an extension of a traditional mesh repair method that was used in patients who may have already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.
WHAT ABOUT THE USE OF A LASER IN ABDOMINAL HERNIA REPAIR?
This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laser hernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no application in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. There has been no evidence that incisions by lasers will decrease pain or decrease healing time.
WHAT KIND OF ANESTHESIA IS USED FOR ABDOMINAL HERNIA SURGERY?
Most hernia repairs can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesia is very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often using sedation medications at the same time to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.
CAN STRENGTHENING THE MUSCLES MAKE AN ABDOMINAL HERNIA GO AWAY?
Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.
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. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, smoking and weight-control problems.
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. However, some infants are born with congenital defects that lead to hernia development.
DO ABDOMINAL HERNIAS USUALLY DEVELOP ON BOTH SIDES OF THE BODY?
Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.
SHOULD ALL ABDOMINAL HERNIAS BE REPAIRED?
In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.
Sometimes, a hernia can be temporarily controlled by wearing a belt-like device that applies external compression, which pushes the tissues back into the abdomen and holds them there. This device is called a truss. The truss must be carefully applied on a daily basis. It should only be used for selected situations following careful evaluation by a doctor.
HOW CAN A PERSON DETERMINE IF A LUMP OR SWELLING IS AN ABDOMINAL HERNIA?
Not all lumps or swellings on the abdominal wall or in the groin are hernias. People should have such lumps or swellings examined by a doctor. Other possible causes include benign or malignant tumors or enlarged lymph nodes. These problems require entirely different types of evaluation and treatments; self-diagnosis may be incorrect and delay needed treatments.