A Hernia occurs when the contents of a body cavity protrude out of the membrane in which they are normally contained through a weak spot in a surrounding muscle or connective tissue. Hernias by themselves may or may not produce symptoms as they are asymptomatic and can cause slight to severe pain. A hernia does not get better with time, nor will it go away by itself (except very small congenital navel hernia). It is seen that men are more prone to inguinal hernias than women because of basic differences in anatomy. The area where hernias occur most often has a very different function in men than in women. However, there is no guaranteed way to prevent getting a hernia or to prevent recurrence of a hernia. Surgery is the only way to cure a hernia as it cannot go away on its own. Now days, many types of surgical hernia repairs are available.
What is Hernia?
A hernia is a weakness or tear in the abdominal muscles that allows fatty tissue or an organ such as the intestines to protrude through the weak area. Hernias can occur in many places in the body, most often in the groin. Sometimes, a weak spot in the abdominal wall can even be present at birth.
Types of Hernia
Inguinal hernias are the most common types of male hernias, that are located in the lower abdomen and thigh, move towards the scrotum, as a bulge in the groin. They are more common in men than women. Inguinal hernias usually occur when fatty tissue or part of a bowel, bulge out through a part of the lower abdominal wall known as inguinal canal.
There are two types of inguinal hernias:
Direct inguinal hernia: They occur as a result of weakness in the floor of the inguinal canal. They are usually bilateral and seen in elderly with chronic conditions which increase intra abdominal pressure such as chronic cough, chronic constipation etc.
Indirect inguinal hernias: They occur when the inguinal canal fails to close before birth. The hernia may appear in a male's scrotum or in the fold of skin at the opening of a female's vagina. This is the most common type of inguinal hernia. And it may occur at birth or later in life. Indirect hernias are more common in males.
Femoral hernias also occur in the groin region just below the groin crease anad more common in women than men. They occur due to a weakness in the lower groin region usually as a result of pregnancy and child. These hernias are more prone to complications and hence should be repaired once they are diagnosed.
An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. These hernias may occur in infants at or just after birth and may resolve by three or four years of age. However, the area of weakness can persist throughout life and can occur in men, women, and children at any time. In adults, umbilical hernias will not resolve and may progressively worsen over time. They are sometimes caused by abdominal pressure or due to overweight, excessive coughing, or pregnancy.
Ventral hernia is a hernia that surfaces on any part of the ventral surface of the human body. It results in a bulge or tear in the ventral surface that develops like a ballon-like sac.
There are three common types of ventral hernias.
An Incisional Hernia is a hernia that occurs through a previously made incision in the abdominal wall, i.e. the scar left from a previous surgical operation
A Periumbilical hernia occurs around the belly button.
An Epigastric hernia occurs above the belly button.
Symptoms of Hernia
Each hernia is different, and the symptoms of a hernia can appear gradually or suddenly. Different people feel varying degrees of pain. Some people even feel that something has ruptured or given way. However, the more intriguing ones are:
- A noticeable protrusion or bulge which may appear on standing or straining and disappear on lying down at the site of hernia.
- The bulge may be more while coughing and sneezing.
- Feeling pain while lifting weight.
- A dull aching sensation
- A vague feeling of fullness
- Nausea and constipation
- Hernias may or may not be painful. In most cases, a hernia can be diagnosed through a physical examination of the abdomen.
Are There Treatment Options for Hernia?
Surgery is the only way to cure a hernia. A hernia will not go away on its own but will increase in size if left untreated. An untreated hernia may also result in obstruction (intestinal blockage) and "strangulation," which requires immediate medical attention. Strangulation occurs when the blood supply to the herniated bowel is cut off or greatly reduced, causing the bowel tissue to die or rupture.The surgical results with smaller hernias are more satisfying as compared to large hernias. Surgery for hernia is:
Laparoscopic surgery: A laparoscopic hernia surgery is a minimally invasive approach that involves the use of laparoscope and allows a laparoscopic surgeon to repair the weakened area through several small incisions (about a half-centimetre), using a non absorbable mesh to cover the weak area.
What Are the Risks for the Surgery?
Infection and/or bleeding are possible after surgery. The risk of complications increases if the patient smokes, takes drugs, is a heavy drinker, is very young or very old, or has other medical conditions.
Advantages of Laparoscopic Hernia Surgery
- It causes lesser pain and patients are able to return to work more quickly than they would after open repair surgery.
- Repair of a recurrent hernia often is easier using laparoscopic techniques than using open surgery.
- It is possible to check for and repair a second hernia on the opposite side at the time of the operation.
- Because smaller incisions are used, laparoscopy gives excellent cosmetic results.
- Minimal postoperative pain
- Quick return to work and normal activities
- Excellent cosmetic results
What are Pre-Surgery and Post Surgery Instructions?
Pre surgery instructions
- Some vital tests are required before surgery.
- Follow your surgeon instructions for any prescribed medications.
- Avoid any medication minimum 5 days prior to the surgery.
- Avoid alcohol and tobacco for few days before surgery.
- One day prior to surgery the patient is not allowed to take anything orally except medicines, after midnight.
Post surgery instructions
- The patient is kept under observation for 2-4 hours and then shifted to the room.
- Patient is allowed to sip oral liquids on the same day of surgery, and can have meals from the next day morning.
- The patient is allowed to move and use the restroom on his own on the same day of the surgery.
- Generally the patient is discharged on the same or on the next day of the surgery.
- The dressings are removed during the first follow up visit which occurs within 2-5 days.
- The patient is instructed to carefully follow the diet instructions as provided by doctor.
- Medication chart is provided to the patient to ensure proper compliance of prescribed medications
- Regular follow up is advised.