Hernia

What Is Hernia?

The symptoms depend on the type of hernia, its causes and the severity. A hernia is a sac formed out of lining of an organ that comes through the hole or weak area in the wall of a muscle, tissue, or membrane that normally holds an organ in place.

A hernia is a bulge or protrusion of an organ or fatty tissue through a weakened area in the muscle or connective tissue in which the organ is enclosed.

A hernia can develop in any part of the body. However, the muscles of the abdominal wall are most commonly affected.

Who Is Affected by Hernia?

Hernia can occur in babies and in adults. Hernia in babies usually heals by itself within four years, but for others, hernia repair surgery or herniorrhaphy is the standard treatment.

Symptoms of Hernia

The main symptom is the appearance of a lump (a swollen area) in the region involved. The lump may be painless and only be felt on exertion such as lifting heavy objects, coughing, etc. Some hernias can cause pain during exertion.

The lump is not felt when the person is lying down; it becomes prominent on standing and particularly on straining. Some hernias can get strangulated, interrupting blood supply to the herniated tissue.

A hernia can protrude from a weak area or opening in the wall of the abdominal cavity. It is seen as a bulge over the skin, and often characterized with 

• Pain
  
• Discomfort. 
  

Hernias are more common in certain parts of the body. Hernias occur most commonly between the area of your rib cage and groin, such as the 

• abdomen
  
• groin 
  
• upper thigh area, and 
  
• belly button area. 

They can also occur in any place where you have had an incision from a previous surgery.

Hernia Diagnosis

A hernia can usually be diagnosed by physical examination (for example: for inguinal hernia, a lump can be seen or felt in the groin). 

Ultrasound and X-rays are other tests that your doctor can order to diagnose hernia.

Types of Hernia

There are different types of hernias based on their location. The most common types are listed below.

• Inguinal
  
• Femoral
  
• Incisional
  
• Umbilical
  
• Hiatal

Inguinal Hernia

Inguinal hernia appears as a bulge in the groin or scrotum, occurring more commonly in men than women. Part of the intestine protrudes through the lower abdominal muscle into the groin.

Fermoral Hernia

Femoral hernia appears as a bulge in the upper thigh, is a loop of intestine, or another part of the abdominal contents, that 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).

This type of hernia tends to occur in older people and is more common in women than in men. 

Fat tissue or part of the intestine protrudes through the abdominal muscle into the femoral artery present in the upper part of the thigh.

Incisional Hernia

Incisional hernia may be caused by the scar if you have had abdominal surgery. Tissue protrudes through a previous surgical wound, which becomes structurally weak.

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.

Fat tissue or part of the intestine protrudes through the abdominal muscle near the belly button.

Hiatal Hernia

Part of the upper stomach protrudes through an opening in the diaphragm into the chest region.

Hernia Treatment

A hernia may need to be treated surgically as it may 

• have a risk of causing pain, 
  
• discomfort or 
  
• even becoming strangulated.
  

Hernia Surgery

A hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital.

The operation may be performed as an 

• Open Surgery
  
• Keyhole Surgery - laparoscopic

There are two types of laparoscopic surgery these are:

The most commonly used laparoscopic surgical techniques for hernia repair are

• transabdominal preperitoneal (TAPP) and 
  
• totally extraperitoneal (TEP) repair.

Open Hernia Surgery

To treat a hernia, your doctor may push the hernia back into its normal location and have you wear a belt to hold the hernia in place.

However, surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated. Surgery aims at closure and repair of the muscle wall through which the hernia protrudes.

Open surgery, also called Herniorrhaphy, for hernia can be done under general or local anaesthesia. Your surgeon makes an incision of about 5-10cm long (depending on the size of the hernia) to view and access the surgical site. Your surgeon pushes the part of the intestine that protrudes back into its normal position and repairs the weakened muscle layer by sewing the edges of the healthy muscle wall together. A synthetic mesh is often placed and sewn over the weakened area to provide additional support and strength, by a procedure called hernioplasty. The incision is closed after the procedure using dissolvable stitches.

Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the abdomen through a small incision. The laparoscope is a small fiber-optic viewing instrument attached with a tiny lens, light source, and video camera.

Laparoscopic surgery is performed in a hospital operating room under general anesthesia. The procedure involves the following:

• A camera attached to the laparoscope displays the image of the abdominal cavity on a screen.
  
• The surgeon makes three small incisions over the abdomen to insert the balloon dissector and trocars (keyholes). 
  
• A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision. 
  
• Once the trocars (key holes) are placed, the keyhole instruments are then inserted to repair the hernia. 
  
• A sheet of mesh is inserted through the top keyhole and positioned and fixed in the abdominal wall to reinforce the repair and help prevent recurrent hernias. After completion of the repair the CO2 gas is evacuated and the trocars are removed and the tiny incisions are closed and dressed with a sterile bandage.