Hernias

A hernia is a weakness or defect in the abdominal wall. It may be present from birth or develop over a period of time. If the defect is large enough, abdominal contents such as the bowel or intra-abdominal fat may protrude, causing a lump or bulge to be observed or felt by the patient.

Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.

Hernias are classified as either primary or recurrent, and are further sub-classified by their anatomical site:

1. Inguinal
2. Femoral
3. Umbilical
4. Ventral (supra-umbilical or epigastric)
5. Incisional
6. Lateral (e.g. Spigelian, para-inguinal, lumbar)
7. Perineal/Pelvic (these are rare)
8. Internal (these are rare)

Certain types of hernias (especially inguinal, femoral, or umbilical hernias) can be fixed as a day only procedure. Other types of hernias (e.g. incisional, Spigelian, para-inguinal, or internal hernias) may be suitable for a laparoscopic or "keyhole" approach

Signs and Symptoms

• Lump or swelling in groin area or in the abdominal wall when standing/straining and which disappears when lying down
• Pain at the site of the lump, especially when lifting heavy objects
• Swelling of the scrotum
• Occasional excruciating abdominal pain (if you have strangulation or entrapment of bowel or fat)
• Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)

Once a hernia has developed, it will either stay the same size or enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or the blood supply may be cut off. This may then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore recommend that hernias be repaired if they cause symptoms, or they are large or cosmetically troubling, if there are no serious medical problems which make an operation risky.

Treatment

Hernia Repair (Surgery)

The traditional method (mostly not done anymore) of hernia repair involves making a large incision over the hernia, and then repairing the defect by suturing it closed. More recently, most surgeons use a prosthetic mesh material to repair the defect to reduce the risk of a recurrent hernia.

Newer hernia repairs involve either a smaller incision open approach using regional nerve blockade or a minimally invasive laparoscopic (keyhole) technique.

A modern “open” technique involves making a small incision directly over the hernia with subsequent placement of the mesh in the anterior layers of the abdominal wall.

In relation to inguinal and femoral hernias, there are two different methods of placing the mesh in the groin. These are known as the “open” technique and the “laparoscopic” technique. The “open” technique involves an incision in the groin directly over the hernia with subsequent placement of the mesh. The “laparoscopic” technique involves making several small incisions around the umbilicus, opening the layers of the abdominal wall with carbon dioxide insufflation, and then placing the mesh down in the pelvis behind the hernial defect. It is important that patients understand there are many minor variations on how to perform both the “open” and the “laparoscopic” operations. You should ask your surgeon exactly what technique they use and request that they discuss the benefits and risks of their preferred technique compared with other options.

What outcome should patients expect after your hernia operation?

After your hernia operation Professor Hugh will provide you with a post-operative brochure which outlines what to expect in terms of the early post-operative period. This brochure also contains advice on diet and exercise in the early post-operative period.

Post Operative Information Brochures