Hernia Repairs
Laparoscopic / Open Hernia Repairs
Hernias is a protrusion of abdominal viscera or fat through a weakness in the muscle wall of the abdomen and forms a bulge underneath the skin. The contents can usually be pushed back into the abdomen with manual pressure.
Types of hernias:
Groin Hernias
Inguinal hernia- commonest groin hernia.
The contents comes out through the inguinal canal and presents as a lump in the lower abdomen extending into the groin or even into the scrotum in the males.
Femoral hernia
The contents pass through the femoral canal presents as a painful lump in the groin. It is commoner in females and requires urgent surgical repair as it has a higher risk of obstruction or strangulation.
Obturator hernia
A very rare hernia where the contents pass through the obturator canal deep in the pelvis. There is no palpable lump and patients usually present with intestinal obstruction with pain in the inner thigh. It is commoner in elderly frail ladies.
Abdominal Wall Hernias
Epigastric hernia
Presents as a lump in the upper central abdomen, in between the breastbone and umbilicus.
Umbilical hernia
Presents as a lump in and around the umbilicus
Spigelian hernia
Rare hernia which presents as a bulge slightly below and lateral to the umbilicus.
Lumbar hernia
Rare hernia where the contents protrude through a gap in the muscle layers in the posterior abdominal wall (back)
Incisional hernia
Herniation of abdominal contents through a weakness in a previous surgical scar
Symptoms
1) Pain
2) Incarceration- contents of the hernia get stuck and cannot be pushed back
3) Obstruction of a bowel loop in the hernial sac causing pain, vomiting, distention of the abdomen and constipation
4) Strangulation- the blood supply to the bowel loop in the hernial sac gets cut off causing intense pain and swelling of the hernia with signs of obstruction
Diagnosis
1) Clinical examination- most hernias can be diagnosed clinically and do not require further investigation
2) Ultrasound scan – to detect small non palpable hernias
3) CT / MRI scan for larger / obstructed / strangulated hernias to plan surgery
Treatment
1) Wait and watch – in small asymptomatic hernias
2) Truss or corsets in hernias which can be reduced
3) Surgical repair – open or keyhole with / without a mesh
Procedure
Hernia repairs are usually done under general anaesthesia but in patients with small hernias it can be done under regional (spinal/epidural) or local anaesthesia. Surgery can be open (where a cut is made over the hernia) or laparoscopic (keyhole with 3-4 small cuts and using a telescopic camera and long instruments). In both the approaches, the hernial contents and the sac is reduced and the weakness in the muscle wall is repaired by sutures or a mesh or both. The wound is then closed by dissolvable stitches and most patients can go the same day.
Mesh is a foreign material made of either synthetic non-absorbable material (Prolene, PTFE or Polyester) or biological (made from animal tissues) which are absorbable or hybrid (combination of synthetic and hybrid). The synthetic meshes are cheaper and are more commonly used. They reinforce the weakened tissues and generate fibrous tissues which help the weakened muscles to heal. The mesh reduces the risk of hernia recurrence but can cause chronic pain and higher infection rates.
Possible complications
Infection, bleeding, recurrence, chronic pain, numbness, injury to bowel or other surrounding structure and seroma formation.
Recovery
1) Take regular painkillers for the first few days
2) Most patients are back to desk jobs in two weeks.
3) Avoid driving for two weeks and make sure you can press the pedals for an emergency stop without pain
4) Can go on short haul flights after two weeks, but please check with your travel insurance company and the airlines
5) Avoid heavy lifting / manual labour for six weeks
Mr Midya performs about 80 hernia repairs every year with minimal complications and good patient satisfaction.
More information can be found on the following links;
https://www.fhft.nhs.uk/patients-and-visitors/patient-information/inguinal-hernia-repair
https://www.britishherniasociety.org/groin-hernia-and-you
https://www.britishherniasociety.org/british-hernia-society-mesh-safety-leaflet/
https://www.nhs.uk/conditions/hernia/