Hernia Surgery
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 of 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).
1. Inguinal Hernias
Inguinal hernias are the most common types of male hernias, that are located in the lower abdomen and thigh going 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.
2. Femoral Hernia
Femoral hernias also occur in the groin region just below the groin crease. They occur due to a weakness in the lower groin region usually as a result of pregnancy and child birth. They are therefore more common in women than men. They are more prone to complications and hence should be repaired once they are diagnosed. Femoral hernias are quite uncommon.
3. Umbilical Hernia
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 due to being overweight, excessive coughing or pregnancy.
4. Ventral Hernia
Ventral hernia is a hernia that surfaces on any part of the front surface of the abdominal wall. It results in a bulge or tearin the ventral surface that develops a baloon-like sac.
There are three common types of ventral hernias.
a) An Incisional Hernia- Hernia that occurs through a previously made incision in the abdominal wall, i.e., the scar left from a previous surgical operation.
b) A Periumbilical Hernia- Occurs around the belly button.
c) An Epigastric Hernia- Occurs above the belly button.
- A noticeable protrusion or bulge which may appear on standing or straining and may 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.
Strangulation of hernia is a surgical emergency in which the getstrangulated in the hernia. It occurs when the blood supply to the herniated bowel is cut off or greatly reduced, causing the bowel tissue to die or rupture. The hernia becomes very painful, does not reduce and the overlying skin becomes red. The patient in this case requires immediate hospitalization and surgery. In case of delay, the intestine may also need to be removed.
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. There is no medical treatment for it. However, the patient should be seen by a surgeon for assessment and deciding the management.
Once detected, for best results, the hernia should be treated as early as possible. Also, early operation will prevent complications like obstruction and strangulation. When compared with large hernias, the surgical results with smaller hernias are more satisfying as compared to large hernias.
Three types of surgeries are generally performed to treat hernia.
- Laparoscopic Surgery: A laparoscopic hernia surgery is a minimally invasive approach that involves the use of laparoscope that allows a laparoscopic surgeon to repair the weakened area through several small incisions that are about half-centimetre in size, using a non-absorbable mesh to cover the weak area.
- Hybrid Laparoscopic Technique: A technique where skin incision may be given in some cases to improve the outcome and also remove the excess/redundant skin for better cosmetic outcomes.
- Conventional (Open): In open surgery, the skin and fat over a hernia are opened, the hernia is located, and a small mesh is placed under the hole -in the muscle. The skin is then closed over the hernia repair site. Open surgery can be used for all types of hernias.
- Laparoscopic surgery has the following advantages over open hernia surgery:
- It causes less pain and patients are able to return to work more quickly than they would after open hernia surgery.
- The recurrence of hernia is very low with minimal complications and chronic pain after operation if performed by surgeons with expertise in dedicated centers of excellence.
- It is possible to check for and repair a second hernia on the opposite side at the time of the operation.
- Since smaller incisions are used, laparoscopy gives excellent cosmetic results.