Hernia is protrude or bulging of intestines or other structures through a hole developed due to weakness of abdominal muscles. The Latin word “Hernia” means rupture or breakage. Hernia usually occurs at the groin region in male and near umbilical area in females.
- Lump: The swelling in the area of weakness will be felt below the skin and fat. It will be more prominent while standing or straining. Usually reduce when person lie down.
- Pain : Same discomfort at the area of swelling is common but severe pain comes only when hernia is obstructed.
- Irreducible Hernia : The intestine which has entered the hernial opening / sac remains there and doesn’t get reduced.
- Obstructed Hernia : There is blockage of the hernia and the intestine in it leading to intense pain, vomiting and distension of intestines.
- Strangulated Hernia: Intestine / bowel which is trapped in the hernia loose its blood supply. Tissue death occur and infections set in. It is a life threatening state and needs emergency surgical intervention.
- Smoking - Reduce muscle strength.
- Obesity – Increased fat deposition lead to hernia especially in women.
- Surgery – The healing after a cut for surgery will not be as strong as before and may lead to development of hernia.
- Increased abdominal pressure – Pregnancy , fluid in abdomen, obesity can precipitate hernia.
- Increased cough, constipation necessitating straining at stool, urinary difficulty, vigorous abdominal exercise can also precipitate hernia.
- Congenital : Holes in abdominal wall from birth may be the reason for hernia in children.
- Inguinal Hernia – In the groin
- Ventral Hernia / Umbilical hernia – Front aspect of abdomen
- Hiatus Hernia – Diaphragmatic hernia ( develops in the diaphragm)
- Lumber Hernia – On the side of abdomen
- Internal Hernia – Seen between intestinal loops
- I. Ultra sound scan/ CT Scan : It can be detect hernia and any other illness in the abdomen which can be tackled along with hernia surgery.
- II. Preop test : Mainly to assess general health and fitness for anesthesia.
- Open surgery : It is performed by a cut over the hernia and then repair of muscle defect with threads and ploy propylene mesh.
- Laparoscopic surgery : It needs only 5- 10 mm cuts away from hernia site. The mesh placement is from inside and hence more physiological and successful. The cuts made are so small then pain and discomfort will be very less and the person can resume regular activities in a week. Much larger mesh placed inside gives more strength for repair and significantly reduced any recurrence. The scars are minimal and hospital stay is only for a day or so. Infection and pain is also significantly minimal in laparoscopy. Though the initial cost is more for laparoscopy the overall benefits and comfort, the time and money saved due to faster resumption of activity makes it economically more feasible.
It is mainly done for women with abdominal apron due to lax skin and excess fat in lower abdomen. In the tummy tuck procedure a long cut is made on the skin and fat at the lower most aspect. There is no muscle cut or opening of abdomen. Muscle weakness is repaired by suturing and placement of mesh.
This procedure gives good correction of abdominal bulge with excellent cosmetic outcome. Women can wear any dress of their liking and they get rid of their inferiority complex.
General problems of Hernia surgery
Bleeding, Infection, anesthesia related issues , mesh rejection, recurrence. But in the modern era of better equipments and perfect sterilization, there complications are negligibly minimal and procedures are very safe.
Do’s and Don’ts to avoid herniation
- Reduce weight
- Moderate exercise
- Quit smoking
- When abdominal surgery needed do laparoscopic surgery then open surgery
- Any hernia to be preferably repaired by laparoscopic method