Hernia is an opening formed by the lining of the abdominal cavity. Abdominal wall hernia occurs when the contents of the intestine bulges out of the abdominal wall. Hernias are developed at birth (congenital) or may appear later (acquired).
Hernias may be present at birth and occurs when the lining around the abdominal organs, fails to close before birth. Hernia may also result if the connective tissue degenerates in the abdominal wall due to which, pressure builds up in the abdominal wall leading to a bulge in the abdomen. Some of the other factors that worsen hernia are chronic cough, obesity, constipation, pregnancy, poor nutrition, smoking and stretching or straining abdominal muscles while lifting heavy objects.
Types of hernias
There are different types of hernias based on their location. The most common types are listed below.
- Inguinal Hernia
- Femoral Hernia
- Hiatus Hernia
- Incisional Hernia
- Umbilical Hernia
- Epigastric hernia
- Spigelian hernia
- Obturator hernia
Some of the commonly observed symptoms include abdominal pain, bulge in the abdominal area, severe groin pain which increases on coughing or lifting heavy things, burning, gurgling sensation, nausea and vomiting.
Your physician can confirm the presence of hernia by performing physical examination. The size of hernia increases on coughing, bending, lifting, or straining. Rarely ultrasound may be needed to look for hernia.
Surgery is the only treatment and is usually performed for hernias that enlarge in size due to increased intra-abdominal pressure causing intestinal obstruction and restricted blood supply which may lead to death of bowel tissues.
A hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital. The operation may be performed as an “open” or “keyhole” (laparoscopic) surgery. Your surgeon will decide which procedure is suitable for the repair and performs with your consent.
In open hernia repair, a large incision is made on the groin (abdomen) and the bulge is pushed back into place. Laparoscopic hernia surgery is a surgical procedure in which a laparoscope (telescope) is inserted into the abdomen through a small incision. The laparoscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera.
- Hernioplasty : This type of procedureis done if the abdominal wall is completely ruptured and damaged. A synthetic mesh is used which is stitched along with the abdominal wall to provide support.
- Herniorrhaphy : This type of procedureis done if the abdominal wall is completely ruptured and damaged. A synthetic mesh is used which is stitched along with the abdominal wall to provide support.
This surgery is performed under general or a local anaesthesia and single large incision is made on the groin area and hernioplasty or herniorrhaphy is performed.
Laparoscopic or Keyhole surgery
This surgery is performed under general anaesthesia and several small incisions are made around the abdomen. Through one of the incision, a laparoscope a small, fiber-optic tube with a tiny camera is inserted. Through the other incisions, surgical instruments are inserted and hernioplasty and herniorrhaphy is performed.
Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. The gas is evacuated at the end of the procedure.
As common with other surgeries, hernia surgery is also associated with certain complications such as local discomfort and stiffness, infection, damage to nerves and blood vessels, bruising, blood clots, wound irritation and urinary retention.
Mesh & hernia repairs
Surgery is the best approach for hernia treatment. Various surgical techniques are used to treat hernias and it is recommended that using ‘tension free’ repair method is beneficial preferably with incisional hernias. Also surgery is recommended for recurrent hernias. In treating larger hernias surgeons use a synthetic material called ‘mesh’ to close the defect or hole. The mesh minimizes the tension at surgical wound and prevents recurrence. Mesh used in surgery also provides support to the weakened abdominal walls. These meshes are available in various sizes and shapes so as to meet the requirements.
Surgeons place this mesh either below of above the defect in the abdominal wall and will be held in place with sutures. This mesh provides support for the growth of new tissue and this tissue incorporates the mesh into surrounding area.