What is hernia?
A hernia occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place. This muscular wall is called the peritoneum. This defect in the peritoneum allows organs and tissues to push through, or herniate, producing a bulge.
Hernias can be found in the following areas
- Groin - a femoral hernia gives a bulge just below the groin (more common in women); an inguinal hernia (more common in men) is a bulge in the groin that may reach the scrotum
- Upper part of the stomach - hiatal or hiatus hernia is the upper part of the stomach pushing up out of the abdominal cavity and into the chest cavity via an opening in the diaphragm
- Belly button - a bulge around here is produced by an umbilical hernia
- Surgical scar - past abdominal surgery can lead to an incisional hernia through the operational scar.
Causes of hernia
With the exception of an incisional hernia (a complication of abdominal surgery), in most cases, there is no obvious reason for a hernia to occur. The risk of hernia increases with age and hernia occurs more commonly in men than in women.
A hernia can be congenital - present at birth - or develop in children who have a weakness in their abdominal wall.
Activities and medical problems that increase pressure on the abdominal wall can lead to a hernia.
- Straining on the toilet (due to long-term constipation, for example)
- Persistent cough
- Cystic fibrosis
- Enlarged prostate
- Straining to urinate
- Being overweight or obese
- Abdominal fluid
- Lifting heavy items
- Peritoneal dialysis
- Poor nutrition
- Physical exertion
Symptoms of hernia
In many cases, hernia is no more than a painless swelling that remains asymptomatic, presenting no problems and needing no immediate medical attention.
Hernia may, however, be the cause of discomfort and pain, with symptoms often becoming worse when standing, straining, or lifting heavy items.
In some cases, hernia necessitates immediate surgery, such as when part of the gut becomes obstructed or strangulated by an inguinal hernia.
Immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as:
The swelling in these cases is typically firm and tender and cannot usually be reduced back up into the abdomen.
Hiatal hernia can produce symptoms of acid reflux, such as heartburn which is caused by stomach acid getting into the esophagus.
Tests and diagnosis of hernia
The diagnosis of a hernia is usually simple - the doctor will often be able to see it and palpate for it.
While the doctor is feeling for the hernia, you may be asked to bend or move, or to cough, as this can enlarge the bulge.
Treatment of hernia
Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia:
- Open surgery
- Laparoscopic operation (keyhole surgery)
Open surgical repair closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with sutures, staples, or surgical glue.
Laparoscopic repair is the treatment of choice these days although it is little expensive, is less likely to cause complications such as infection.
Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.
The hernia is repaired in the same way as in open surgery but is guided by a small camera and a light introduced through a tube.5 Surgical instruments are introduced through a further small incision. The abdomen is inflated with gas to improve visualization and space and the whole operation is performed under general anesthetic.
Benefits of Laparoscopic Hernia repair
- It gives best cosmetic results, and leaves no scars
- The recovery time is less
- Least surgical pain
- Patient can resume daily activity after a week
Disadvantages of Laparoscopic Hernia repair
- Not ideally suited for complex Hernia cases
- Higher chances of re-occurrence, unless surgery is carried out perfectly by highly trained surgeon
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