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Overview

A hernia occurs in the abdomen when a piece of tissue or an organ sticks out through one of the weakened muscle walls that surround the abdominal cavity. The sac that swells through the weak muscle area in the groin or abdominal wall contains the fatty lining of the colon or a piece of intestine.

In case if a hernia occurs via the diaphragm, the muscles that separate the abdomen from the chest, then the sac may contain a part of the stomach. They are the most common in the stomach, but they can also appear in the groin areas, belly button, and upper thighs. Groin hernias are most commonly of the inguinal type but may also be femoral.

In most cases, hernias are not life-threatening, but they don’t go on their own. They might require hernia operation or hernia surgery to prevent potentially hazardous complications.

Common Types of Hernia

There are mainly four types of hernias affecting the humans

Inguinal Hernia

Repair of a hernia in the groin (an inguinal hernia) is the most frequently performed operation in general surgery. The hernia is repaired (with suturing or placing a synthetic mesh over the hernia in one of the layers of the abdominal wall) using either open surgery or minimal access laparoscopy. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different as the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the thin membrane covering the organs in the abdomen (the peritoneum).

Hiatal Hernia

This type of hernia occurs when a piece of your stomach tissue sticks out through your diaphragm into your chest cavity. A hiatal hernia is a common disorder amongst individuals aged 50 and above.

Umbilical Hernia

This type of hernia is the most common in newborns under 6 months old. An umbilical hernia occurs when a child’s intestine bulge through his/her weak abdominal wall.

Hernias also can be birth defects. A congenital diaphragmatic hernia occurs when your diaphragm doesn’t form right. This can create space for your stomach to move into your chest. Sometimes doctors find the defect when you are a baby.

Femoral hernias

Femoral hernias also happen when fatty tissue or part of your bowel pokes through into your groin at the top of your inner thigh.

They're much less common than inguinal hernias and tend to affect more women than men.

Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the tummy.

Incisional Hernia

An incisional hernia occurs rarely after you have undergone an abdominal surgery.

Muscle hernias

Where part of a muscle pokes through your tummy; they also occur in leg muscles as the result of a sports injury.

Epigastric hernias

Where fatty tissue pokes through your tummy, between your belly button and the lower part of your breastbone

Spigelian hernias

Where part of your bowel pokes through your tummy at the side of your abdominal muscle, below your belly button.

Sign & Symptoms

The most common sign of hernia occurrence is the formation of lump or bulge in the affected area. In case of an inguinal hernia, you may notice bulginess on either side of your pubic bone where your thigh and groin meet. You can feel your hernia by touching during when you bend down, cough, or stand up.

Signs and symptoms of an inguinal hernia

  • Aching, gurgling, or burning sensation at the site of the lump.
  • Experiencing heaviness, pressure, or weakness in the abdomen.
  • Discomfort or pain in the affected area while lifting, coughing, or bending.

Signs and symptoms of a hiatal hernia

  • Difficulty in swallowing
  • Chest pain
  • Acid reflux

Signs and symptoms of an umbilical hernia

Your baby might have a hernia is he/she has a bulge near the belly button.

Investigation & Diagnosis

  • The best doctor for hernia will make sure to perform all the tests and diagnosis to determine the type of hernia in the patients.
  • Incisional or inguinal hernias are diagnosed via a physical examination.
  • Hiatal hernia is diagnosed using endoscopy or with a barium x-ray.
  • Umbilical hernia is diagnosed using ultrasound
  • Further, a CT scan or MRI is also performed for diagnosing a hernia.


Treatment Modalities

Laparoscopic hernia repair surgery / operation is considered the best treatment option for hernia. However, it will depend on the symptoms and the size of your hernia to determine the treatment options. The possible treatment options for hernia include


Surgery / Operation

You will require an inguinal hernia surgery / operation if your hernia is causing pain or is growing larger. Laparoscopic surgery / operation is considered the most common surgery for hernia. It involves miniaturized surgical equipment and a tiny camera along with few small incisions. However, it requires long recovery processes and you may not be able to move freely or normally for 5-6 weeks.


Medication

Hiatal hernias can be treated using certain prescribed medications that condense the stomach acid. Proton pump inhibitors, H2 receptor blockers, and antacids are the potential medicines for hiatal hernias.


Laparoscopic surgery for Hernia

- Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia

- Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair


Procedure & Advantage

Transabdominal preperitoneal patch (TAPP) repair of inguinal hernia

Buttressing the posterior wall of the inguinal canal by laparoscopic insertion of a preperitoneal synthetic or biological mesh.

Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair

The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes.

Frequently asked questions

When can I drive again?

Driving is generally not recommended for at least 48 hours following surgery because the effects of anaesthesia are still present in the body. Driving also puts a strain on the incision site. In addition, if you are taking pain medication, you may not be able to drive or operate machinery. Ask your surgeon when it is safe for you to resume driving.

Should I have laparoscopic or open surgery?

There are three main advantages of keyhole surgery:

  • The small incisions result in less pain and earlier return to work, especially when hernias are present on both sides.
  • The positioning of the mesh on the inside of the defect is mechanically better than when placed on the outside as in the non-keyhole operation.
  • By positioning the mesh on the inside of the defect, the very sensitive nerves in the inguinal canal are not damaged or irritated by the mesh as can occur in the non-keyhole operation.

For recurrent hernias, keyhole surgery is also useful.

A surgeon using the open technique has to dissect through tissue that is much scarred from the first operation. This is much more difficult than a first-time operation and can lead to increased risks of complications. If the operation is done with the keyhole technique, the hernia is approached from the inside, where the tissue has not been affected by the first operation. This makes it much easier for the surgeon, and less painful for the patient.

Possible disadvantages of keyhole surgery

  • The operation can sometimes take longer. With experienced surgeons however there is very little difference in time taken between the keyhole and non-keyhole operation.
  • In the exceptionally rare situation of a complication of the mesh, such as infection or mesh rejection, the mesh is more difficult to remove than when it is on the outside of the muscles as with the non-keyhole operation.
  • Cost: Because the surgeon uses some disposable instruments during keyhole surgery, the cost is higher than open surgery.

Are hernias hereditary?

You may inherit a tendency to have weak abdominal muscles from one of your parents, but hernias themselves are either acquired or congenital. Acquired hernias are caused by the wear and tear of living, such as childbirth, weight gain, and other muscle strain. Congenital hernias are present when you are born with points of weakness in the abdominal wall. Children’s hernias are almost always congenital. Many adult hernias are also congenital but may have been too small to detect at an earlier age.

Should I wear a hernia truss?

Probably not. Trusses, which are devices designed to hold the bulge of an inguinal hernia in place, may or may not make you more comfortable for a while, but they don’t treat the hernia. Some experts feel they may make a hernia worse. Talk to your doctor before you decide to try a hernia truss, which should only be used as a temporary measure, if at all.

How Does Hernia Mesh Work?

Hernia mesh reinforces tissue around the hernia. Doctors attach it with sutures, staples or tacks. Over time, tissue grows into the mesh’s pores. This strengthens the repair.

My surgeon mentioned the need for hernia mesh. What is it and why is it required?

Surgical mesh used for hernia repair is quite common. In fact, as of 2000, fewer than 10% of groin hernia repairs were performed without the use of mesh implants. The surgical mesh helps to reduce the development of another hernia after surgery. It also reinforces and strengthens the damaged area in need of repair.

Can a hernia be prevented or avoided?

You cannot always prevent hernias. Some are caused by genetics that you can’t avoid. A congenital diaphragmatic hernia is a birth defect. You also can be born with weak muscles that make it easier to get a hernia later in life. You can reduce your chance of getting some types of hernias by: Eating smaller meals Losing weight if you are obese Avoiding or limiting alcohol and tobacco Avoiding or limiting certain foods (such as things that are spicy or high in fiber) Using proper lifting techniques to prevent strains.

Do I need to have my stitches removed?

No. The stitches are beneath the skin and they dissolve. None of the mesh we have implanted has ever needed to be removed.

How big is the incision?

Most of our incisions are about 1 ½ inches. They can be a bit longer depending on your weight.

How long will I be out of work?

It’s you who decide when you are comfortable to resume regular duties. Most of our patients will be back to their jobs in a week, though this can vary.

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