Hernia – Questions and Answers

What is a hernia

A hernia or “rupture” is an abnormal protrusion of the internal organ or its lining through a weak area or tear in the muscle of the abdominal wall. Fatty lining of the bowel may protrude through the weak point and present as a bulge or swelling.

What are the causes of a hernia?

There are potential areas of weakness in our abdominal wall muscles in all of us which may be made worse as a result of aging, things that we are born with (congenital), trauma and as a result of previous surgery. When these potential areas of weakness give way, a hernia occurs as a result.

Are there factors or conditions that predispose to formation of hernia? – Certain factors and conditions may make the formation of hernia more likely. These include:

  • Heavy lifting
  • Chronic constipation
  • Carrying excess weight
  • Chronic cough

Types of hernia

Different types of hernia occur in different parts of the abdominal wall. The commonest type of hernia occurs in the groin (inguinal hernia) and is 10 times more common in men. Femoral hernia also occurs in the groin area but is less common. However, it is 9 times more common in females and is most likely to strangulate than all other hernias put together.

Other types of hernia occur around the navel (umbilical hernia), above the umbilicus (paraumbilical, or epigastric hernia), or through a previous surgical incision (incisional hernia).

Hiatus hernia is different because it is internal whereby the stomach and sometimes other organs go into the chest cavity through a weakness in the diaphragm which is the muscle that separates the abdomen from the chest.

 

What are the symptoms of a hernia?

Most commonly people notice a swelling or lump say in the groin area, which may be uncomfortable or even painful especially on coughing or straining. The lump usually reduces on lying down and protrudes on standing. A feeling of dragging sensation in the groin is not uncommon in some people.

How is a hernia diagnosed?

A history and physical examination are enough to diagnose majority of hernias. Most people will notice a bulge or swelling in the groin area, for example, which reduces on lying down. Occasionally the symptoms may not be clear as to suggest a hernia in which case a scan may be required to confirm the diagnosis.

Is it safe to leave hernia untreated?

Hernias do not mend themselves without surgical repair. However, certain types of hernias can be left untreated if they are small and not causing any symptoms. All femoral hernias on the other hand should be repaired as soon as possible to avoid the risk of bowel strangulation.

Inguinal hernias should be repaired if they are getting bigger and causing pain or discomfort that interferes with everyday living and leisure activities.

When should I seek immediate medical attention for a hernia?

You should seek immediate medical attention for your hernia if your hernia becomes irreducible and painful with or without the following features:

  • Associated vomiting and distension of the abdomen
  • Constipation
  • Discolouration of the skin over the hernia
  • Fast pulse rate

These symptoms will indicate incarceration and possible strangulation of the hernia and immediate surgical repair is mandatory to avoid organ damage.

What are the types of surgical repair?

Hernia can be repaired by two techniques, which are good operations depending on your individual circumstances and the local expertise available to you. Hernia repairs are performed as day case procedures.

  • Open repair – a single cut is made over the hernia which is then reduced and a repair performed using a patch or mesh that strengthens the weak area. This technique is also referred to as the Lichtenstein technique for groin hernia repairs.
  • Keyhole or laparoscopic repair – the surgeon makes little incisions (5-10mm, usually three cuts) to insert the camera and working instruments to allow for the hernia to be repaired also using a mesh.

Which type of hernia surgery is the best?

The type of hernia repair is usually tailored according to the individual circumstances. Your surgeon will discuss the options with you and both of you will choose the best method that will suit you as an individual. Keyhole hernia surgery has the advantages of:

  • Less pain because of the small cuts
  • Quicker physical recovery and earlier return to work, school and leisure activities
  • Less wound complications such as infection, wound swelling and bruising
  • Lower risk of chronic groin pain post -surgery for groin hernia repairs
  • Best suited for inguinal hernia on both sides of the groin and recurrent hernia repairs

Keyhole hernia surgery may in some situations carry higher risk of damage to internal organs and therefore will not be advisable. Check with your surgeon about their experience and complication rate.

Open hernia repair may be suitable for the elderly patients who may not be fit for general anaesthesia and for those in poor health who have troublesome hernia.

What is the recovery after an operation?

This depends on the type of hernia surgery you have had and also your type of work. If your hernia is performed through the keyhole, you should be recovered within a week to ten days after surgery. You may not be able to drive for about a week after your surgery and before you start driving it is always advisable to check with your car insurance company to inform them that you had an operation. For open hernia repairs you may have to allow an extra week or two.

You will be able to take some walks a few days after your surgery and gradually increase your level of activities.

Are there risks associated with hernia surgery?

These are generally few and include risks of general anaesthesia and risks specific to the actual hernia repair including wound infection, wound swelling and bruising, chronic groin pain and the risk of the hernia coming back. However, these are in the minority of patients while the majority of people would have a smooth recovery and a good outcome.