General Surgeon, Darwin

 

Hernias

A hernia is the protrusion of an organ and its coverings through an opening that does not normally transmit it. Abdominal wall hernias occur when the contents of the abdominal cavity bulge out of the abdominal wall. Hernias may be present at birth (congenital) or may develop later in life (acquired). Acquired abdominal wall hernias may develop if the supporting structures of the abdominal wall weaken, and if pressure builds up in the abdominal wall. Some other factors that worsen hernias include chronic cough, obesity, constipation, pregnancy, poor nutrition, smoking and stretching or straining abdominal muscles while lifting heavy objects.

Hernia Types

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

Uncommon hernias include:

  • Epigastric hernia
  • Spigelian hernia
  • Obturator hernia

Symptoms

Symptoms include pain and a bulge in the abdominal area, or pain which increases on coughing or lifting heavy things. Other symptoms include burning, gurgling sensation, nausea and vomiting.

Your surgeon 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, as it is generally poorly reliable for evaluating groin hernias.

Treatment

Conservative management – the wearing of a truss – is reasonable for those few patients in whom the disadvantages of potentially curative surgery outweigh the advantages.

Surgery is the only curative treatment and is usually performed in otherwise healthy persons for hernias that have no symptoms, or that enlarge in size due to increased intra-abdominal pressure. Surgery must be performed for complications such as intestinal obstruction and restricted blood supply (strangulation) of the herniating organs.
A hernia repair is usually performed as an inpatient surgery with a one or more night stay in hospital. The operation may be performed as an “open” or “keyhole” (laparoscopic) surgery.

Your surgeon will discuss with you which procedure is suitable for the repair prior to you determining how you wish to proceed.

In open hernia repair, an incision is made near or the hernia lump 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 telescope made up of a tiny lens, light source and video camera.

Inguinal Hernia

An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal at the groin region. Symptoms are present in about two thirds of people. This may include pain or discomfort especially with coughing, exercise, or going to the toilet. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down.

Femoral Hernia

Femoral hernia appears as a bulge in the upper thigh, where a loop of intestine or another part of the abdominal contents has been forced out of the abdomen through a channel called the “femoral canal” (a tube-shaped passage at the top of the front of the thigh). It most commonly develops in women due to the wider pelvic region and also in older people.
Femoral hernias may be congenital but usually develop later in life. Certain factors such as chronic constipation, obesity, and stressful urination because of enlarged prostate may increase the risk of hernias. Patients with femoral hernias may have a bulge in upper thigh area and may have symptoms such as abdominal pain, nausea and vomiting, and discomfort on standing or lifting heavy objects.

Hiatus Hernia

Normally, the stomach is completely below the diaphragm. In individuals with a hiatus hernia part of the stomach slides upwards through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen, and protrudes into chest cavity. Hiatus hernia is very common and affects people of all ages.

Obesity, chronic cough, chronic constipation, smoking, and hereditary factors increases the risk of developing hiatus hernias. Hiatus hernia may not cause any symptoms but patients may experience chest pain, heart burn, belching, and hiccups and other features of gastro-oesophageal reflux disease.

A hiatus hernia usually does not need surgical treatment, unless symptoms are significant or the hernia is very large.

Incisional Hernia

An incisional hernia occurs through a scar of any previous surgical incision made in the abdomen and usually develops after many years of surgery. Incisional hernias are usually small and only the peritoneum or tissue layer lining the abdominal cavity protrudes out. Incisional hernias are more common in obese individuals and in pregnant women. Risk is more in those who had multiple surgeries earlier and those who perform activities that impart more stress of abdomen.

Patients may experience pain and discomfort and there is always a risk of recurrence.

Umbilical Hernia

Umbilical hernia is a small bulge around the umbilicus (belly button). An umbilical hernia in an infant is caused by the incomplete closure of the muscles around the umbilicus. Smaller umbilical hernias often require no treatment and close by the age of 2 however larger umbilical hernias may necessitate surgical intervention. In adults not al umbilical hernias need surgery, unless they are large or cause symptoms.

Recurrent Hernia

Recurrent hernias as the name implies recur at the same site of earlier hernia. Recurrence is more common in obese individuals and those who had multiple surgeries earlier. Recurrence is more common with incisional hernias because the risk factors such as obesity may persist and cause recurrence.

Surgery is the best approach for recurrent hernias however the difficulty or complications increase on subsequent repairs. Recurrent hernias can be repaired with open surgery or laparoscopic surgeries. Certain preventive measures such as treating chronic cough before treating hernias, avoiding smoking, avoiding strain on abdomen during bowel movement, and avoiding lifting of heavy objects may help in preventing recurrence.

Mesh and Hernia Repairs

Surgery is usually 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. 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 under the skin, either over or under to the defect in the abdominal wall. This mesh provides support for the growth of new tissue and this tissue incorporates the mesh into surrounding area.

 

 

 

 

 

 

Mr John Treacy, General Surgery in Darwin
Darwin General Surgeon Mr John Treacy
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