Hernias

What is a hernia?

A hernia is a “weakness” in the muscles of the abdominal wall that allows the contents of the abdomen to bulge out. The most common points of weakness are the groin (the most common type), around the umbilicus (or tummy button), the upper abdomen (epigastric hernias), through old surgical scars (incisional hernias) and around the site of colostomies (para-stomal hernias). Patients often notice a bulge under the skin that may become larger on standing or lifting and may disappear when lying down. Hernias often cause discomfort or a dragging sensation and occasionally severe pain.

How does a hernia form?

Hernias may arise in one of two ways. They may develop from a weakness of the abdominal wall present from birth. These are usually found in childhood or early adulthood. More commonly, hernias occur with ageing when the muscles of the abdominal wall become weak.

What is the best treatment for a hernia?

An operation is often the best way to manage a hernia though this depends on the type of hernia, the symptoms the patient is experiencing and the possible risks that performing surgery may pose to the patient’s general health. In some cases, it is perfectly safe to leave the hernia alone. Despite being popular in the past, the use of a support belt or “truss” to control a hernia is rarely used nowadays since they are generally ineffective, tend to be uncomfortable and should only be used with direct medical supervision.

Groin hernias in particular may be treated with an operation under local anesthetic so the patient is not put to sleep. This allows even patients with severe breathing and heart problems to undergo a surgical repair. Most hernia repairs are performed using a synthetic mesh that is used to cover the weakness in the muscles. The mesh does not hold the hernia back in place itself but allows the body to form scar tissue that strengthens the weakness and closes the defect.

What is a strangulated hernia?

The main risk caused by a hernia is strangulation. This occurs when the hole in the abdominal wall through which the hernia passes is narrow and obstructs the blood supply to the contents of the hernia. If left untreated, this may lead to perforation of the bowel and spillage of intestinal contents into the hernia or abdomen. Strangulation may have occurred if the hernia becomes hard, if is difficult to reduce back into the abdomen or if it suddenly becomes very painful and the patient starts to vomit. If any of these symptoms occur you should see you doctor immediately.

Surgical options for hernia repair

Open hernia surgery
Standard hernia surgery is a tried and tested method and allows many hernias to be repaired without the need for a general anaesthetic. With the use of synthetic mesh to re-enforce the hernia repair, recurrence rates have fallen to as low as 1% for many types of hernia.
Laparoscopic (Key hole) hernia surgery
Laparoscopic surgery uses a telescope to look inside the abdomen. It has become a popular method in treating many hernias. The major benefits are the patient has smaller incisions than the more traditional open technique, experiences less pain and and return to normal activity much faster.

What is the recovery after an operation?

Most hernia repairs are well tolerated by patients and can be performed as a day case or with a short overnight hospital stay. Mild pain-killers may be needed but the majority of patients return to full activity within a few days. Although hernias can come back, the risk of this can be reduced by simple measures such as losing weight and stopping smoking.

What should I do if I think I have a hernia?

If you think that you have a hernia you should make an appointment to see your doctor who will be able to reassure you or refer you on to a specialist surgeon who can advise if an operation may be necessary.