Hernia Surgery

What is Hernia?

The bulging of an internal organ or tissue through the wall of the muscle wherein it usually resides is called a hernia. It commonly occurs in the abdominal wall where the intestine pushes through a weak area in the wall, usually the inguinal canal and this results in inguinal hernia which is the most common type of hernia.

What are the types of hernia?

The common types of hernia are:

Inguinal hernia – When the intestine protrudes through one of two openings in the lower abdominal wall called inguinal canals, it causes pain in the inner groin area.

Femoral hernia – Deep passages called femoral canals appear in the upper thigh/outer groin area. If a part of a tissues pushes through this area it results in femoral hernia. They are significantly less prevalent than inguinal hernias, and they affect women more than men. This can result in a high-risk condition if not repaired at the earliest.

Ventral hernia – It occurs through an opening in the abdominal muscle. A ventral hernia is further classified into three types. They are:

Epigastric hernia – This occurs above the bellybutton

Incisional hernias – They are caused by a weakening of the abdominal muscle as a result of a previous abdominal surgery wound.

Umbilical hernia – It occurs near the belly button. This type of hernia is very common in infants who are born prematurely. By the time the child turns four, the hernia heals by itself. It can be more serious if it occurs in adults.

Umbilical open hernia technique – This technique involves a dissection of tissue to provide a mesh overlap of 3 cm to 5 cm beyond the fascial defect’s outer edge. At 1-cm intervals, the mesh is secured with interrupted long-term absorbable sutures. Polypropylene or nylon mesh is utilized to make the repair. After any defect repair such as required under this technique that necessitates extensive subcutaneous tissue dissection and leads to bleeding or the creation of dead space, drains are implanted.

Umbilical laparoscopic hernia technique – After inspecting the abdominal cavity with the laparoscope, two 5-mm trocars are put as far away as feasible from the hernia defect for laparoscopic repair. Blunt and sharp dissection with judicious use of electric cautery or harmonic arc are used to decrease the contents of the hernia. The mesh is measured with the abdomen deflated, allowing for at least a 3 cm to 5 cm overlap beyond the borders of the fascial defect, and is secured with tacks and full thickness sutures made of non-absorbable suture material, or tacks are placed every centimeter and full thickness sutures are placed every 3 cm to 5 cm.

Hiatal hernia – When the top half of the stomach bulges into the chest through a small opening in the diaphragm (the hiatus), it causes heartburn. The esophagus, which transports food from the mouth to the stomach, can pass through the diaphragm.

What are the symptoms of a hernia?

A lump or protrusion accompanied by discomfort or pain is a common symptom of most hernias. The lump or bulge may or may not be present at all times; for example, it may disappear when the patient lies down. Symptoms worsen when the patient stands, strains or tries to lift heavy objects. Doctors confirm the presence of a hernia during a physical exam in most cases or sometimes through imaging techniques.

On the other hand, hiatal hernia does not cause a bulge rather symptoms such as heartburn, acid reflux and regurgitation of food or liquids occur that can be treated with medication.

• Immediate surgery is required if the following signs are observed.
• A bulge that is larger than before
• A bulge that gets back inside the abdomen usually but suddenly does not go back
• Fever
• Redness in the area affected with hernia
• Tenderness in the area of a hernia
• Abdominal pain, bloating, nausea and vomiting

How is a hernia surgery carried out?

Most symptoms of Hiatal hernias can be treated with medicine, while most other types of hernias require surgical correction. There are two main types of procedure to rectify hernias:

Open hernia surgery – To see and repair the hernia, the surgeon cuts through the groin. After treating the hernia, the surgeon closes the abdominal wall with only stitches or if required, stitches along with a mesh. The mesh is intended to strengthen the weak portion of the abdominal wall where the hernia had developed.

Laparoscopic hernia surgery – The surgeon makes multiple small cuts (usually three) in the lower belly and inserts special tools and a special camera for visualization of the affected area. This procedure carries lower risk and involves minimal scarring. However, it might not be possible to recommend this procedure in case of more complicated cases. To seal and strengthen the abdominal wall, the surgeon usually employs a piece of mesh. Some surgeons prefer robotic surgery, which includes sitting at a console and controlling the robotic arms that execute the procedure.

While mesh is commonly used and is proven to help reduce hernia recurrence, it also has significant drawbacks in some cases, including persistent pain.

What can you expect during the post-surgical care for hernia?

Hernia operations are usually performed as outpatient procedures. In general, the sooner a patient can get up and move, the better. Constipation and blood clots can be avoided with this exercise. The doctor will direct the patients as to what they can lift, how they can lift it, and for how long. The doctor will also recommend long term and short-term precautions that patients will need to follow.