Hernia

What is a hernia?

A hernia is an out-pouching of intra-abdominal contents through a defect or hole in the muscle. The abdominal muscles and bones of the pelvis prevent abdominal contents from drooping out under normal circumstances. The skin and fat below the skin do not provide any strength and stretch if there is a hernia present.

Hernias can occur anywhere in the abdomen, but most commonly occur at weak points where a small tear can start, and enlarge over time. The common weak points are:

Inguinal – This is the most common in men, the weak point is near where the spermatic cord courses through the muscle

Femoral – Here the weak point is where the blood vessels to the thigh and leg pass through at the bottom of the pelvis

Umbilical – Hernias around the belly button are common and often present as an ‘outie’ type umbilicus

Incisional – Scar tissue after previous surgery is weaker than the surrounding muscle and can tear to form a hernia

Epigastric – Some people get hernias in the region between the belly button and the breast bone

Predisposing factors

It is not always possible to identify the time when a hernia started, although sometimes that is the case. Hernias are often associated with either weak muscles or raised abdominal pressure (or both). Predisposing factors include:

A history of heavy lifting
Male Sex
Obesity
Chronic cough, constipation or urinary retention
Previous surgery

Symptoms of hernia

There are frequently no symptoms of hernia. When present, the common symptoms are:

A lump that comes and goes and is more prominent on standing or straining
Pain, discomfort or 'dragging' sensation at the site
Incarceration or strangulation (see below)

Hernia Complications

Hernias do not repair themselves. Over time hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the hernia will develop a complication.

Incarceration occurs with a long term (chronic) hernia where the contents come out and stay out and are unable to be pushed back in. This often causes discomfort or mild to moderate pain but not severe pain.
Strangulation is where in the short term the contents come out and cannot be pushed back in, and where the defect causes such pressure on the blood vessels that the contents are starved of blood supply. This causes swelling, and severe pain. This is an emergency and warrants prompt attention at hospital.

Who needs a hernia repair?

Patients with hernias, who are fit enough to undergo surgery should have hernias repaired before complications occur. Patients with strangulated hernias require urgent repair.

What tests are done?

Most commonly hernias are diagnosed clinically by your doctor. Sometimes ultrasound and/or CT scans can help rule out other causes of symptoms and diagnose the hernia. Tests to ensure safety of anaesthesia are performed according to age group and risk factors.

How is the hernia repaired?

The principle of hernia repair is to reduce the contents back into the abdominal cavity and close the muscle. There are various techniques for closing the muscle and Dr Pulitano will discuss the options and make recommendations in your instance. In general, small defects can be closed with a simple stitch technique, whereas larger defects are best dealt with by placing an artificial mesh over the hole, with the advantage that a large area is covered, and there is no tension on the repair that would encourage stitches to pull through and lead to a recurrence.

Can it be repaired with laparoscopic (keyhole) surgery?

Yes, this is the most common method of repair, although it is not suitable for everyone. The advantage of laparoscopic repair is that there is less pain and therefore a quicker return to normal, and sporting activities.

The postoperative course

The post operative course is different for each person. Most patients go home on the day of or the day after surgery.

Sutures are dissolving and buried, dressings can stay on for 7 days.

A follow-up appointment is made for 3 weeks after surgery. You may eat and drink normally, and walk around straight away. Heavy lifting and vigorous sports should be avoided for 6 weeks after the surgery.