What is hernia?
Is defined as abnormal protrusion (bulge) of abdominal viscera through a weakened part of abdominal wall. A hernia does not get better over time, nor will it go away by itself. It always becomes bigger with time.
What are the common types?
The common sites of hernia are groin (inguinal and femoral), belly button (umbilical) and at the site of previous surgery (incisional). There are many more types but are not common.
Who are at risk of getting hernia?
Anyone can get hernia, New born to Elderly persons. At risk are Persons engaged in hard labor like lifting heavy goods, with chronic cough, straining for passing urine and stools, smokers, obese persons with previous open abdominal surgeries are common to get hernia.
How to detect or diagnose hernia?
Hernia is easy to recognize, usually presenting as bulge under the skin especially on standing or straining and disappears on lying down. Pain may or may not be present with the bulge. Hernia can present as emergency if the bulge is not reducing, associated with pain and vomiting (Strangulation/ Obstruction In such case patient should visit the surgeon as soon as possible. Ultrasound scan, sometimes CT scan is required for diagnosing very small hernias and in obese patients.
When to take treatment?
Once hernia is detected it should be treated as early as possible, according to new guidelines hernia should be repaired with mesh within 1month of diagnosis. Early surgery will prevent complications like obstruction and strangulation.
What is the treatment for hernia?
Surgery is the only treatment for hernia. No medicine will cure it.
What are the Complications of hernia if not treated?
- Can increase in size causing discomfort or pain.
- Can become irreducible
- Can lead to obstruction/strangulation – where hernia requires emergency surgery.
What are the types of surgery for hernia?
Surgery for hernia is of two types
- Open surgery
- Laparoscopic surgery (Endoscopic/keyhole/Minimally invasive surgery). In both types of surgery hernia is repaired using a MESH.
How is Laparoscopic surgery for hernia performed?
Three (two 5mm and one 10mm sized) incisions are made and cannulas placed in them. A laparoscope (long narrow telescope) connected to a special camera is inserted through a cannula, allowing the surgeon to view the hernia and surrounding area on a video screen. Other cannulas are inserted under vision which allow the surgeon to work inside the abdomen. A surgical Mesh is fixed over the hernia defect and held in place with small surgical staples and/or sutures.
How is the open surgery for hernia performed?
In Open operation a cut is made over the body (according to site of hernia) and tissues dissected out till the hernia defect is identified. The hernia bag/sac is opened and contents of hernia sac are pushed back into abdomen and bag is excised. Defect is closed. Mesh is applied over and surrounding the defect and fixed in place with sutures.
What are the advantages of Laparoscopic surgery for hernia over the conventional open surgery?
The advantages are many, few are:
- Much less pain.
- Patients are able to walk within few hours of surgery.
- Patients are discharged early from hospital within one or two days after surgery
- Patients are allowed to resume routine activities early (within 5-7 days)
- Both sides of inguinal hernia can be operated with the same three incisions.
- Cosmetic results are excellent.
Is it necessary to use MESH in the repair of all hernias?
Yes. It is standard principle that MESH should be applied in the repair of hernia in majority of patients to strengthen the defect whether the surgery is done by open or Laparoscopic method. Only childhood hernias are repaired without using MESH.
Is it safe to undergo Laparoscopic repair for hernia?
Yes. If done by a properly trained surgeon in a well- equipped centre it is a safe surgery with excellent results.
Under what circumstances a Laparoscopic surgery cannot be done?
Laparoscopic hernia repair may not be possible if:
- If the hernia is very large in size
- If a patient can’t receive general anesthesia
- If a patient had multiple complicated abdominal surgeries
What are the complications of surgery?
The complications of hernia surgery are:
- Seroma- collection of whitish fluid in the wound (commonest complication).
- Hematoma- collection of blood in the wound.
- Mesh infection- most dreaded complication. Requires removal of mesh, thorough washing of wound and culture based antibiotics
- Pain at operative site. Usually subsides with normal pain killers.
- Recurrence – Failure of surgery and re-appearing of the hernia.
What is the length of stay in hospital?
Hospital stay following laparoscopic hernia surgery is lessas compared to open surgery.
- Laparoscopic hernia surgery – 1 to 2 days for all hernias
- Open hernia surgery – 3 or more as per type of hernia
What precautions have to be taken after undergoing hernia surgery?
- Should not lift weight for 3 months.
- Should stop smoking.
- Should lose weight if obese.
- Should have regular follow up if a person is suffering from chronic cough or has straining while passing urine or stools should take treatment for the condition.
Dr Lokesh HM
Consultant, Gastroenterology- Surgical
Narayana Multispecialty Hospital, Mysore