Hernia

Hernia

A hernia is the protrusion of an organ or the covering of the organ through a defect in the wall of the cavity that normally contains it. By far the most common hernias develop in the abdomen, when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tyre, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.

A person may be born with a hernia (congenital) or develop one over time. A hernia does not get better over time, nor will it go away by itself.
Although men are more likely to develop hernias, they also occur in women and children.
 
Procedure     

It is generally advisable to repair hernias quickly in order to prevent complications. Most abdominal hernias can be surgically repaired and recovery rarely requires long-term changes in lifestyle. In laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient's belly button.
 
Two other small cuts are made (each no larger ½ -1 inch) in the lower abdomen. The hernia defect is reinforced with a 'mesh' (synthetic material) and secured in place.
 
There are different types of a hernia that occur when the intestineor any tissue protrudes at the different sites of the abdomen.
  • Inguinal hernia - most common hernia that occurs in the groin region.
  • Hiatal hernia - occurs at the diaphragm, through a muscle that separates the chest from the abdomen.
  • Incisional hernia - occurs at the surgical wound in the abdomen that has healed with a weakened spot in the muscle.
  • Umbilical hernia - occurs at the navel region.
  • Epigastric hernias occur at the upper abdomen in the midline.
 
infographics
What is the cause of a hernia?

Hernias mainly occur due to a weakness of the abdominal wall that allows the contents of the abdomen to be pushed out with straining. Muscle weakness is due to various reasonssuch as:
  • Failure of the abdominal wall to close properly in the womb. This is a congenital defect and may occur during childhood or adolescence.
  • Advancing age: As you age the muscles lose their tone and a hernia may develop.
  • Damage due to injury.
  • Pregnancy which adds pressure on the abdomen and stretches the abdominal wall.
  • Improper lifting of heavy objects.
  • Constipation which may strain the abdominal region during a bowel movement.
  • Persistent coughing or sneezing.
  • Sudden weight gain.
  • Conditions such ascystic fibrosis also increase the risk of developing a hernia.
  • Cigarette smoking also contributes to the development of a hernia.
 
Although a hernia bulge may occur suddenly, hernias often take years to develop. They grow larger as pressure inside the abdomen pushes the intestines or other tissues out through the weak area.
 
What are the symptoms?

Having a lump or bulge in the affected region is the striking symptom of a hernia. Other symptoms depend upon the size and location of the hernia.
  • If you have inguinal hernia, you may feel a lump in the region where the groin and upper thigh meet.
  • You feel pain and discomfort that is worse at the end of the day or after standing for long periods.
  • Pain while bending, coughing, or lifting objects.
  • A feeling of weakness or pressure in the groin.
  • Discomfort or pain during urination or bowel movements.
  • You may not be able to swallow food comfortably and you may feel a burning sensation in the chest region in the case of a hiatal hernia.
 
What are the implications of having a hernia?

Over time all hernias get bigger. If the hernia is not treated, there are chances that you may develop complications. In some cases, a loop of intestine may become tightly trapped by muscle tissue which can cause severe pain and requires immediate treatment. The blood supply to the intestinal part which is trapped in the hernia may get cut off. This may lead to the intestine developing gangrene accompanied with severe abdominal pain, nausea and vomiting. At this stage, you will have to undergo emergency surgery to remove the damaged intestine. Therefore, you should take immediate action to avoid all these complications.
Surgery is needed to repair the defect in the abdominal wall.
 
How does surgery work?

Surgery treats a hernia by repairing the weakness in the abdominal wall. To repair the defect, muscle and connective tissue may be sutured together to make a traditional repair. Or special mesh materials are used to patch the weak area and make a tension free repair.
 
The surgery is performed mainly by two techniques: open surgery and key-hole or laparoscopic surgery.
Key-hole surgery is a simple laparoscopic technique in which a hernia is repaired by making small incisions and placing a mesh at the affected site.
 
How do you prepare for surgery?

Your doctor will evaluate you regarding your symptoms and overall health. You will also be examined. You will need to do some tests to make sure you’re in good health for surgery.
Follow your doctor’s advice on how to get ready for the procedure. You can usually go home the same day of surgery, though in some cases you may have to stay overnight.
 
  • Tell your doctor about any medicines, supplements or herbs you may be taking.
  • Stop taking aspirin, ibuprofen or naproxen as directed.
  • Arrange for an adult family member or friend to take you home after surgery.
  • Stop smoking a few weeks before the surgery, for an early healing.
  • Avoid eating or drinking from midnight on the night before surgery.
 
What happens during hernia repair?

Your surgery will be done under regional anaesthesia, general anaesthesia or local anaesthesia with monitored sedation.
Depending on your medical history, your surgeon will decide whether you should have open or laparoscopic surgery.

Procedure for open surgery:
  • After the operative site is cleaned, an incision 3 to 4 cm long is made.  
  • The surgeon places the intestine or other tissues inside the hernia sac back into the abdominal cavity. The defect in the abdominal wall is repaired either by sewing the abdominal tissues using sutures (herniorraphy) or by attaching a mesh over the weak area (hernioplasty).
  • In the end, the incision is closed with stitches or staples and surgical tape.  
 
Procedure for laparoscopic surgery:
  • Your surgeon makes several very small incisions-one incision about 1.5 cm long is made below the belly button, and two incisions about 0.5 cm long on the sides of the main incision.  
  • After inflating the abdomen using carbon dioxide gas, your surgeon passes the laparoscopic instruments into the abdomen through the incisions.
  • Then he repairs the hernia with a mesh.
  • After the completion of the repair, your skin is sealed with the stitches or surgical glue.
 
What can you expect post-surgery?
 
  • You will be taken to the recovery area to rest where you will be monitored.
  • You will experience discomfort and pain around the sutures for a few days after the surgery but you will be given some pain medications. Open surgery will be more painful compared to laparoscopy.  
  • You will be given breathing exercises to keep your lungs clear and later you will be asked to get up and walk. This helps to prevent blood clots in the legs.
  • You can go home when your doctor feels that you’re ready.
  • Some bruising and swelling are also common which subsides after few weeks.
  • You may develop scars at the incision site, but they will disappear after complete recovery. 

What are the possible complications of surgery?

These include the risk of infections, bleeding, bowel or bladder injury, inability to pass urine, risks associated with anaesthesia and the risk of recurrence though remote.
 
When can the patient first walk after the surgery?

You can start walking slowly the very next day of the surgery. You may feel pain initially, but you should continue walking, to improve blood circulation in your legs.
 
When can the patient return home after the surgery?

For open surgery, you will have to stay in the hospital for 2-3 days depending on your clinical condition. If you had laparoscopic surgery, you are most likely to get discharged on the same day, or you may need to stay back for one night if not completely recovered.  
 
How soon can you return to normal activities?

Help make your surgery a success by taking an active role in your recovery. Start by easing back into your routine with short walks. Recovery for open surgery is nearly 3 weeks, after which you can perform light activities. You can perform strenuous exercises only after 6 weeks. However, the recovery with laparoscopic surgery is faster, and you may return to normal activities within 1-2 weeks.
 
What precautions must a patient take after hernia repair surgery?

You should follow certain precautions after the surgery, for an easy and fast recovery.
  • Take frequent short walks to improve circulation and prevent blood clots in your legs.
  • Avoid lifting heavy objects for at least a week.
  • Eat a healthy diet and drink enough water. Have a diet with adequate amounts of fiber to prevent constipation.
  • Follow the doctor appointments as scheduled.
  • Call your doctor immediately when you have:
  • fever of 101°F or higher
  • difficulty urinating
  • uncontrollable pain, nausea, and vomiting
  • bleeding at the surgical site
  • excess swelling and bruising
  • excessive redness or drainage at the incision. 

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