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What is it?

A hernia is a weakness in the muscles of the front of the body wall. Usually, the bowel or some fat, and more rarely other organs, can push through this weak spot and create a bulge in the area. In this case the hernia is in the groin. Sometimes they are in both groins. They can be caused by the body wall being weak from birth. Sometimes the body wall weakens with the passing of time. Other times, the body is overstrained by coughing, heavy work, multiple pregnancies or sport. Hernias are very common and are easily treated. If left untreated, they get bigger and cause pain. More dangerously, the bowel can sometimes get trapped in the weak spot of the muscles. This can cause a blockage of the bowel, which can eventually cause it to become strangulated and necrotic (where the blood supply is cut off). An emergency operation is then required to deal with the problem. For children, please see ‘Child's inguinal hernia operation.

Symptoms

An incisional hernia causes a bulge in the abdominal area. Often, this type of hernia is painless, but may be tender and can cause discomfort during any type of physical strain, such as lifting heavy objects, coughing, or straining during bowel movements.

The bulge may disappear when lying down, and be more visible when standing up.

Symptoms include pain, which may be a sharp or dull ache that feels worse towards the end of the day. Other symptoms include nausea, vomiting, and the inability to have a bowel movement. Continuous or severe discomfort, or nausea related to the bulge are signs that the hernia may be entrapped or strangulated. If you have these symptoms, be sure to contact your physician immediately.

Types of Hernia

For information on a specific type of hernia see:

1] Inguinal hernia

Inguinal hernia appears as a bulge in the groin or scrotum. This type is more common in men than women.

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Causes

Family history of hernias

Cystic fibrosis

Undescended testicles

Extra weight

Chronic cough

Chronic constipation, straining to have bowel movements

Enlarged prostate, straining to urinate

Symptoms

Groin discomfort or groin pain aggravated by bending or lifting

A tender groin lump or scrotum lump

A nontender bulge or lump in children

Treatment

Most hernias can be pushed back into the abdominal cavity. However, if it cannot be pushed back through the abdominal wall, this can lead to a strangulated loop of intestine. If left untreated, this portion of the intestine dies because of loss of blood supply.

Almost all hernias require surgery, preferably before complications occur, to reposition the herniated loop of intestine and secure the weakened muscles in the abdomen.

2] Femoral hernia

A femoral hernia is the sticking out of a part of the intestine through a weakening in the abdominal wall near the thigh.

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Symptoms

Groin discomfort or groin pain aggravated by bending or lifting

Tender lump in the groin or upper thigh

Treatment

Hernias generally get larger with time, and they usually do not go away on their own. If the patient's health allows, surgery is done to relieve discomfort and to prevent complications such as incarceration and strangulation. Often, a piece of plastic mesh is surgically placed to repair the defect in the abdominal wall.

Urgent surgery is required a hernia that may be trapped or strangulated.

3] Hiatal hernia

Incisional hernia can occur through a scar if you have had abdominal surgery.

The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth to the stomach.The esophagus passes through the diaphragm just before it meets the stomach, through an opening called the esophageal hiatus.

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Symptoms

Severe heartburn

Severe inflammation of the esophagus from the backflow of gastric fluid (reflux)

Narrowing of the opening (hiatus) through the diaphragm (esophageal stricture)

Chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids

Treatment While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the abdomen.

4] Umbilical hernia

An umbilical hernia is an outward bulging (protrusion) of the abdominal lining or part of the abdominal organ(s) through the area around the belly button.

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Symptoms

A hernia can vary in width from less than 1 centimeter to more than 5 centimeters.

There is a soft swelling over the belly button that often bulges when the baby sits up, cries, or strains. The bulge may be flat when the infant lies on the back and is quiet.

Treatment

Usually, no treatment is needed unless the hernia continues past age 3 or 4. In very rare cases, bowel or other tissue can bulge out and lose its blood supply (become strangulated). This is an emergency needing surgery.

Risk factors for recurrence of Hernia

There are several reasons why a hernia may return:

Wound infection following the original operation - this means the tissues may not heal properly and remain weak.

Inadequate repair the first time around.

Post-operative strain on the wound - if you put too much strain on the muscles and other tissues in the area soon after it's been mended, you may undo the surgeon's hard work and cause a weakness to develop in the muscles. Always follow instructions closely after a hernia operation.

Chronic strain on the abdominal muscles - this could be caused by problems such as putting on a lot of weight.

Treatment of Hernia

Open Surgery

The type of anesthesia utilized during open hernia repair surgery depends on the patient's and the physician's preference, as well as the health of the patient. Choice of anesthesia includes general, which renders the patient unconscious and prevents memory of the surgery; epidural or spinal, which numbs a large area of the body; and local, which numbs the immediate area around the hernia. Local and spinal anesthetics are often used with sedation, which induces drowsiness.

Once the anesthesia has taken effect, the area around the hernia is cleaned thoroughly with an antiseptic solution to prevent postoperative infection. The surgeon makes an incision near the location of the hernia. For an inguinal hernia, the incision is made just above the crease where the abdomen meets the thigh. To repair an umbilical hernia, it is made close to the navel. If the hernia has occurred at the site of a previous operation, the incision from that surgery is reopened.

Surgery proceeds in much the same way, regardless of where the incision is made. The hernia sac is carefully opened and the intestine or other tissue is placed back inside the abdomen. The weakened area is repaired and reinforced with a synthetic mesh or a suture that pulls the abdominal muscle tissue back together. The entire procedure takes about 1 hour in adults and 30 minutes in children.

Laparoscopic Surgery

Laparoscopic surgery can be used for hernia repair. Instead of one long incision, four or five tiny incisions are made in the area around the hernia. A device called a laparoscope, which is a miniature scope attached to a video camera, is inserted into one of the incisions. The surgeon is able to see the hernia and the surrounding tissue and organs on a video screen.

Instruments used to repair the hernia are inserted through the other incisions and the operation proceeds in much the same way as open surgery. Advantages of this technique include shorter recovery time and less postoperative pain. A major disadvantage is that it must be performed under general anesthesia, which carries far more risks than local or epidural anesthesia. Laparoscopic hernia repair has only been used for a few years, and while research shows it to be safe and effective, long-term results are unavailable.

Eligibility for laparoscopic surgery depends on a number of factors. The surgeon must be able to see the interior of the abdomen clearly, and sometimes obesity or large amounts of scar tissue make that difficult. Also, the patient may not be a good candidate because other health problems prohibit the use of general anesthesia. The choice of surgical procedure is based on patient safety.