SURGICAL CONDITIONS

General Surgery

Hernias

A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient.

Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.

Signs and Symptoms

• A lump, particularly when standing/straining - it may disappear when lying down
• Pain at the site of the lump, especially when lifting a heavy object
• Pain – this is variable. Some hernias are painless, others cause a dragging ache – a strangulated hernia will cause severe localized pain.
• Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)

What happens if hernias are not treated?

Once a hernia has developed, it will tend to enlarge and cause discomfort. They never resolve spontaneously. Exercises cannot reduce the size of a hernia. Wearing a truss (support) is uncomfortable and does not reduce the risk of the hernia causing complications. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off (strangulated hernia). This could then become a life-threatening situation. Since hernias can be repaired effectively, it is nearly always advised that hernias be repaired when diagnosed, unless there is serious medical problem which makes it too risky. Many hernias can be repaired without even requiring a general anaesthetic, so it is rare that surgery is not possible.

Treatment

Hernia repair (Surgery)

Nearly all hernias in adults are now repaired with mesh. The risk of recurrence is unacceptably high when the hernias are just repaired with sutures (stitches). In the past, surgeons have been wary of using mesh as some of the older materials had an unacceptable risk of becoming infected – and therefore needing to be removed. Modern meshes are made from Polypopylene, EPTFE (Goretex™) or combinations of the two. Other materials such as titanium and Polyglycolic acid are sometimes combined with Polypropylene. All of these meshes have a very low incidence of infection and are never rejected.

Common Types of Hernia

Inguinal Hernia: This is the most common type of hernia. It is more common in men. It occurs in the groin where the spermatic cord passes through the muscles of the abdomen. Some babies are born with an inguinal hernia. However, it can occur at any age. You will probably have noticed a lump and perhaps some pain in the groin. The lump may be worse at the end of the day and disappear overnight.

Inguinal hernias can be repaired with open or laparoscopic (keyhole) surgery. Although laparoscopic surgery has advantages for many procedures, there is no convincing evidence that it is superior for inguinal hernia repair. The complication rate of laparoscopic hernia repair is higher. I generally recommend an open hernia repair, most commonly using the Plug and Patch Technique, however, I also use the Kugel Patch, particularly in recurrent hernias. Occasionally, I will suggest a laparoscopic repair, particularly if there is a need to also see inside the abdomen.

Most inguinal hernias can be repaired on a day case basis, provided you have someone at home to take care of you. Most people will need to take 1 to 2 weeks off work after surgery.

To download a PDF document regarding inguinal hernia repair click here: Download

Femoral Hernia: These are more common in women than men. They also occur in the groin and cause a lump, often with some pain. They are particularly prone to cause strangulation of the bowel. I also repair these with a mesh plug or patch.

Incisional Hernias: These occur after previous operations where the wound has not healed soundly. They are particularly common in obese people and/or if the original wound was infected. The results from conventional sutured repair are very poor with a high recurrence rate. Mesh should always be used. Many surgeons repair these with an open approach, placing the mesh on top of the muscle. This can be quite satisfactory, but there is still a significant recurrence rate and there are often wound problems due to the large amount of tissue dissection that is required. The alternative is to place the mesh inside the abdomen, which provides a stronger repair. However, it is very important that only specialized meshes designed to reduce the risk of adhesions are used inside the abdomen.