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What is a hernia?
A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.
Serious complications from a hernia result from the trapping of tissues in the hernia—a process called incarceration. Trapped tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.
Symptoms of hernias
- A noticeable protrusion in the groin area or in the abdomen
- Feeling pain while lifting
- A dull aching sensation
- A vague feeling of fullness
- Nausea and constipation
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness in the abdominal wall present at birth. Anyone can get a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate, and hernias to form.
Types of hernia
- Inguinal hernia
- Femoral hernia
- Umbilical hernia
- Incisional hernia
1] Inguinal or Groin Hernias
Inguinal or groin hernias are the most common type of hernia to occur.
Inguinal hernias are much more common in men.
Symptoms include a bulge in the groin area that may be accompanied by pain or a dull ache when standing for prolonged periods of time, when doing heavy lifting, coughing or straining.
2] Umbilical Hernia
Umbilical hernias result from a weakness in the abdominal wall at the site of your belly button.
Persons at higher risk for umbilical hernias are people who may have had prior surgery at the site of their belly button, women who have had children, and the obese.
Symptoms include a bulge in the area that may be accompanied by pain or a dull ache when standing for prolonged periods of time, when doing heavy lifting, coughing or straining.
3] Ventral/Incisional Hernia
A ventral/incisional hernia can occur any where on the abdominal wall. If you have had prior surgery on your abdomen this type of hernia may occur at the site of your scar.
Symptoms can include a bulge in the area that may be accompanied by pain or a dull ache when standing for prolonged periods of time, when doing heavy lifting, coughing or straining.
Surgical methods currently employed to repair hernias include open surgery and laparoscopic surgery. A hiatal hernia is corrected by a surgical procedure called Nissen fundoplication.
- 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.
- Pain in the cord that carries sperm from the testicle to the penis (spermatic cord), in the testicles, or in the thighs.
- Fluid (seromas) or blood (hematomas) in the scrotum, the inguinal canal, or the abdominal muscles.
- Inability to urinate (urinary retention) or bladder injury.
- Infection from the mesh or stitches.
- Scar tissue formation (adhesions).
- Injury to abdominal organs, blood vessels, and nerves.
- Numbness in the thigh.
- Pain in the thigh (nerve entrapment).
- Injury to the testicle, causing testicular atrophy (rare).
- Recurrence of the hernia (usually related to the mesh applied during surgery being too small to cover the groin area or the mesh not being stapled well).
Benefits of laparoscopic hernia surgery
- Three tiny scars rather than one large abdominal incision
- Short hospital stay (You might leave the day of surgery or the first day after surgery)
- Reduced post-operative pain
- Low hospital costs
- Faster return to work
- Shorter recovery time and earlier resumption of daily activities (a recovery time of days instead of weeks)
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