WHAT IS A HERNIA?

A hernia is the protrusion of tissue from its natural site through an adjacent orifice or weakened tissue space. Examples are inguinal, femoral, and umbilical herniae, in which the intestine pushes its way through the weak sites in the abdominal wall. The herniae emerge as externally protruding masses in the groin, over the upper thigh, and at the navel, respectively. A hernia is also called a 'rupture' and can occur at any age in both sexes. It is very common and in children and young adults it is due to congenital defect (present from birth).

What causes a hernia?

Apart from congenital defects, hernia can be age-related weaknesses in the abdominal wall, the result of strenuous activities or excessive strain on the abdominal wall. Heavy lifting, straining due to constipation or chronic cough could enhance the cause.
Around one in ten people suffer from hernias.

Types of Hernia

Inguinal Hernia

An inguinal hernia is the most common type of hernia affecting both male and female. It is presented as a lump in the groin that may disappear when lying flat and may be pushed back, only to reappear while standing, coughing or straining. It can cause discomfort and increase in size with time. However if it becomes strangulated or very painful, urgent surgical treatment will be required.

Femoral Hernia

Although less common than inguinal hernia, femoral hernia is more common in women than men. It is usually presented as a lump at the crease of the lower groin and upper thigh area. The protruding lump is more likely to get stuck than an inguinal hernia and would need prompt repair.

Umbilical Hernia

An umbilical hernia is very common in children but more common in women than men. It presents itself around the navel due to weaknesses in the muscle wall around the umbilicus.

Incisional Hernia

This type of hernia occurs where an incision has been made in a previous operation. The underlying scar tissue has weakened over the time and allows the intestines to bulge through forming an incisional hernia. Surgical repair is most appropriate in this situation.

Epigastric Hernia

An epigastric hernia occurs in the upper abdomen between the sternum and the navel. It is due to weakness in the upper abdominal muscles causing a bulge to appear in that area. It could be either small or quite large and more common in middle age group and requires surgical repair.

Symptoms of a hernia

An ache or discomfort may be felt in the groin area (or elsewhere) accompanied by a lump or swelling. The swelling could be less apparent when lying flat or first thing in the morning and becomes more noticeable as the day goes by.

Can hernia be dangerous?

Generally there is no immediate danger, if the hernia can be pushed back or flattened, although it could be uncomfortable. However, if left untreated, the hernia will increase in size and can be associated with the risk of strangulation (where part of the intestines is trapped in the hernial sac), and threatening blood supply to the rest of gut.
This is a rare situation but needs immediate surgical intervention to prevent acute blockage, which may lead to perforation of the bowel and peritonitis. Hernia should normally be repaired unless there is serious medical condition preventing surgery.

How can my hernia be repaired?

There are several methods of repairing a hernia, the conventional method of repair (the Bassini or Shouldice method) consists of bringing and stitching of the edge of the tear together. However, the stitching distorts the muscles fibres and creates undue tension along the stitch line, which results in additional pain and longer recovery period.

The "Tension-free" mesh technique (Lichtenstein method) is the repair achieved by applying a mesh patch to cover the hernial opening instead of sewing the edge of the hole together. This (polypropylene) patch covers the hernia completely and is "tension-free". The edge of the patch is tacked in place by clips or stitched in position with non-absorbable material.

The "Mesh Plug" method is typically used for the repair of femoral hernia. Although not so common, the femoral hernia is the type of groin hernia where the patient's intestine may push out through the femoral canal. This canal can be closed off by the insertion of a "plug" made of polypropylene mesh or repaired by the conventional method of stitching the edge together.

The Laparoscopic Method is a tension-free procedure performed by tele-guidance through three keyholes in the abdomen where instruments are inserted and guided by the images on a video monitor. This method is less traumatic but requires expert surgeons in laparoscopic surgery. In this procedure a polypropylene mesh patch is inserted and held in place by metal clips. In endoscopic hernia repair, there is less chance of a recurrence.

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1. This is an endoscopic picture of an inguinal hernia. The large hole ia around the inguinal ring which can allow the internal organs to push through the inguinal canal when standing up. This hole is repaired with a prolene mesh.

2. In this picture, the defect is repaired with a prolene mesh. The internal organs cannot push through now.