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Hernia - Commonly Asked Questions
What is a hernia?
A hernia is a defect or a weak spot that develops in a muscle and/or connective tissue around it {called fascia}. The underlying organ or fat protrudes out. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).
What are the common types of hernias?
1. Inguinal hernia
This is the most common form of hernia. It occurs in the groin and most commonly in males. In inguinal hernia, intestine or the bladder protrudes through the groin.
2. Incisional hernia
It is the second most common form of hernia. In this type, the intestine or abdominal fat starts coming out at the site of previous abdominal surgery where weakness has developed. This type of hernia develops more commonly in elderly or overweight patients or those who develop infection over the incision site after the initial surgery.
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3. Femoral hernia
Though less common, also occurs in the groin. It is more common in females.
4. Umbilical hernia
It occurs at the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children. It also occurs in patients with liver cirrhosis.
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5. Paraumbilical hernia
Paraumbilical hernia occurs near the naval. The treatment method for umbilical and paraumbilical hernia usually remains the same as they both occur at sites with are close to each other.
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6. Hiatal Hernia
In hiatal hernia stomach squeezes through a natural opening in the diaphragm.
What are the risk factors for developing hernia?
Anything that increases pressure in the abdomen for a prolonged period of time can cause a hernia, such as:
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As a birth defect
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Lifting heavy objects without stabilizing the abdominal muscles
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Prolonged Diarrhoea or constipation
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Pregnancy
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Obesity
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Smoking
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Poor nutrition
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Enlarged prostate {BPH} causes obstruction of urine and increase abdominal pressure
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Is there a medical treatment of a hernia?
These is no medical treatment for it. Hernia is surgical problem. The defect requires to be closed by an operation.
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How do I know that I have a hernia?
You will be able to see a bulge at a place where there was none before. The bulge may disappear completely on lying down or pressing from above.
Usually hernias are asymptomatic to start with. That is, they do not cause any pain , fever etc. Though they have slight pain or dragging sensation to start with.
The bulge may get bigger with time. It may also not be possible to reduce it like before if it becomes obstructed.
If the diagnosis is not readily apparent in some cases, radiological imaging tests such as an abdominal ultrasound, CT scan or MRI might be needed.
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Does hernia regress on its own? Or Can I live with hernia without a surgery?
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Unfortunately, the answer is NO. Hernia does not regress on its own. It usually increases in size over a period of time.
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How do I know if my hernia is serious? Or
What are the possible complications of a hernia? Or
What are the long term effects of hernia? Or
What happens if I do no get my hernia treated?
The most common problem with prolonged hernia is that because of contract pressure on the muscle, over a period of time, the muscle further weakens and the defect/ hernia grows bigger in size. It is important to understand that just like smaller defects and holes are easier to repair, hernia surgery too has better results when size is small. The risk of recurrence is less in small hernias as compared to larger hernias.
Obstructed hernia. Sometimes the contents of hernia that come out of the defect may get stuck in this defect. This make the hernia irreducible and painful. If intestines get stuck in the defect then it can result in obstruction of the intestines and patient develops severe pain, vomiting and distension of the abdomen. Obstructed hernia is a surgical emergency.
A more severe condition is a strangulated hernia. This happens if the blood supply of the contents coming out of the defect get trapped and get cut off . This condition reuired immediate medical attention as this is a life threatening condition.
Treatment plans are entirely depending on types and severity of hernias as well as patient’s overall health status. If hernia is left untreated, the size of protruding intestine might get bigger and become strangulated leading to the reduction of blood flow to surrounding tissue. Urgent treatment must be provided in order to prevent related complications such as bowel obstruction and necrotizing enterocolitis (severe inflammation of intestines).
What is the right time to get surgery for hernia? Is it urgent to get a hernia surgery or can I postpone it?
One will usually be advised to get hernia surgery as a planned case without any undue delay if it is still reducible and not complicated.
Painful or enlarging hernias usually require surgical treatment to relieve discomfort and prevent other serious complications.
If complications of incarceration/ irreducibility develop the hernia should be operated immediately to prevent any life threatening complications.
In case of life threatening complications of obstruction or strangulation urgent surgery is required. The surgery is a emergency surgery to save a patient's life.
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There are two general types of hernia surgery:
Various options for hernia surgery
Open hernia repair
An incision/cut is made over the defect. The contents coming out of the defect are reduced and placed back in their original place the defect is closed with sutures.. Usually as mesh is required to strengthen the repair.
Minimally Invasive Surgery: Laparoscopic repair
In this minimally invasive procedure, instead of making an open cut, the surgeon operates through 3 small incisions in the abdomen. A small tube attached with a tiny camera (laparoscope) is inserted into one incision. Guided by this camera, the surgeon then inserts tiny instruments through other incisions to repair the hernia by pushing protruding tissue back in place. To enhance the strength of muscles in the abdominal wall, during this surgery, “synthetic mesh” will be implanted to provide additional support to weakened areas. The majority of surgical mesh devices currently available for use are constructed from safe synthetic materials, sized 10 x 15 cm. Not only reducing the tenderness and pain after surgery, but mesh repair done by highly experienced surgeons also significantly helps minimizing the chance of hernia recurrence. This procedure requires general anesthesia and it takes approximately 45-60 minutes. Since the surgical incisions are only 5-10 mm. long, it subsequently results in minimized pain and shorter hospital stay with faster recovery time and a quick return to daily activities.
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Should I opt for laparoscopic or open hernia surgery?
This depends on multiple factors.
Laparoscopic hernia surgery is more suitable for some incisional hernias, umbilical hernias or paraumbilical hernias especially if they are large.The recovery and recurrence risk may be lesser with laparoscopic surgery in such cases.
The scar is much less with laparoscopic surgery. Laparoscopic surgery has tiny scars which anyways fade with time and remain hardly visible.
If the patient's medical condition does not allow general anesthesia, which is a must for laparoscopic repair, then patient may have to go for open surgery which can safely be performed under spinal anesthesia.
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There are several factors why your surgeon may suggest one approach over the other. One should discuss the advantages and disadvantages of both the approaches with their surgeon before making a final decision.
When can I resume work after a hernia surgery?
Recovery time ins hernia patients depends with the type and size of hernia. If also depends on patients medical conditions, age, muscular strength, nutrition.
In inguinal hernia repair the repair time is usually not very long.
In general, open hernia repair patients will enquire 6 - 8 weeks before they can start lifting heavy weights. Laparoscopic hernia repair patients are able to resume daily activities and work earlier as compared to those with open technique. They will be able to lift weighted objects earlier as compared to open surgery patients.