Hernia Surgery

Hernia Patient Awareness Information

What is hernia?

A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. For example, the intestines may break through a weakened area in the abdominal wall.  Hernias usually do not get healed on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia, and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.

  • An abdominal hernia occurs when an organ or other piece of tissue protrudes through a weakening in one of the muscle walls that encloses the abdominal cavity.
  • A hernia usually shows up as a bulge in the abdomen, upper thigh, belly button and groin areas.

What are the different types of hernia?

  • Inguinal hernia – The most common type of hernia; it’s more common in men than women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. It develops in the inner groin region (inguinal canal).
  • Incisional hernia – Can occur from previous incision (after you’ve had an abdominal surgery).
  • Femoral hernia – Can occur in outer groin region.
  • Umbilical hernia – Can occur in children and babies under 6 months old at abdominal wall near the bellybutton/navel.
  • Hiatal hernia – Can occur when the upper stomach squeezes through the hiatus, an opening in the diaphragm.

What causes hernias?

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes, the muscle weakness is present at birth; more often, it occurs later in life. Anything that causes an increase in pressure with muscle weakness in the abdomen can cause a hernia, including:

  • Lifting heavy objects without stabilising the abdominal muscles
  • Diarrhoea or constipation
  • Persistent coughing or sneezing

In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.

How common are hernias?

People from the 40-70 year age group are most prone to develop hernia. Male to female ratio is normally 7:1.

How is hernia detected?

A physical exam is usually all that’s needed to diagnose a hernia. Your doctor will check for a bulge in the area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.

What are the symptoms of hernia?

There are three kinds of symptoms of hernia; each of these are explained below:

Reducible hernia

  • It may appear as a new lump in the groin or other abdominal area.
  • It may ache but is not tender when touched.
  • Sometimes pain precedes the discovery of the lump.
  • The lump increases in size when standing or when abdominal pressure is increased (such as coughing).
  • It may be reduced (pushed back into the abdomen) unless very large.

Irreducible hernia

  • It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
  • Some may be chronic (occur over a long term) without pain.
  • An irreducible hernia is also known as an incarcerated hernia.
  • It can lead to strangulation (blood supply being cut off to tissue in the hernia).
  • Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Strangulated hernia

  • This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
  • Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
  • The affected person may appear ill with or without fever.
  • This condition is a surgical emergency.

Reason for Hernia Surgery

The need for treatment depends on the size of your hernia and the severity of your symptoms. Treatment options for a hernia include lifestyle changes and medication.

Lifestyle changes- Dietary changes can often treat the symptoms of a hiatal hernia, but won’t make the hernia go away. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.

Medication- If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors. 

Hernia Surgery Procedure

A hernia surgery is usually the only way of treatment. The three main types of hernia surgery are open repair, laparoscopic (minimally invasive) repair, and robotic repair. Let us understand each type of procedure in detail.

A hernia patient has two surgical treatment options available to them, depending on their particular case. Each of these are explained below:

Open Hernia Repair

  • In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anaesthesia to sedate or help the person sleep, or a combination of the two.
  • Then the surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches Open hernia surgery is performed with an incision, or cut in the groin. The hernia sac containing the bulging intestine is identified. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with sutures or synthetic mesh. Most patients are discharged a few hours after surgery, and resume normal work within a few days. Strenuous activity and exercise are restricted for four to six weeks after the surgery. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support; an operation called hernioplasty.

Laparoscopic Inguinal Hernia Repair

A laparoscopic (minimally invasive) hernia surgery uses a small incision into which the laparoscope is inserted. The instruments to repair the hernia are inserted through other small incisions in the lower abdomen. This procedure (Laparoscopic surgery) is usually performed under general anesthesia, so before the surgery, patient will have an evaluation of his/her general state of health. There is no or less pain during this surgery.

The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope – a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh. The abdomen is inflated with a harmless gas (carbon dioxide), which creates space to allow the surgeon to view internal organs. Mesh is then placed over the defect to reinforce the abdomen wall and strengthen the tissue.  After the procedure is completed, the small abdominal incisions are closed with suture stitches or skin stapler or with surgical tape. Within a few months, the incisions are barely visible.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine whether the laparoscopic surgery is the best option or not if the hernia is very large or the person has had pelvic surgery. Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when the patient may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.

Benefits of laparoscopic hernia surgery include three to four tiny scars rather than one larger incision, less pain after surgery, a quicker return to work, a shorter recovery time (days instead of weeks) and lesser incidents of infection.

Robotic Hernia Repair Surgery

Robotic hernia surgery, like laparoscopic hernia surgery, uses a laparoscope and is performed in the same manner (small incisions, a tiny camera, inflation of the abdomen, projecting the inside of the abdomen onto television screens).

Robotic surgery differs from laparoscopic surgery in that the surgeon is seated at a console in the operating room, and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.

One of the biggest difference between laparoscopic surgery and robotic surgery is that the use of the robot provides excellent three-dimensional images of the inside of the abdomen (vs. the two-dimensional images of laparoscopic surgery).

Few major advantages of Robotic vs. Laparoscopic or Open Hernia Surgery are:

  • Wristed instrumentation (similar to having your hands in a small space)
  • 3D stabilized magnified view
  • Autonomous control for surgeon of three instruments and a camera
  • More ergonomic for surgeon

Other benefits of robotic hernia surgery are common to that of laparoscopic surgery which includes tiny scars rather than one large incision scar, less pain after this surgery compared to open hernia surgery, faster recovery & lesser chances of infection.

Use of Mesh in Hernia Surgery

  • Surgeons today can select from a wide range of mesh material & designs available in the market which will suit best as per the location of defect & type of hernia surgery.

What is a Mesh?

The term "mesh" is used to describe a flat sheet of prosthetic material that is used to cover, or "patch," a hernia.

Why a Mesh?

Decades ago, hernia repair was performed by simply suturing the hernia defect. For some types of hernias, this repair resulted in 25-50% of hernias later returning. Introduction of mesh changed this scenario. By using mesh, the chance of hernia recurrence dropped to the low single-digits.

Meril Endo Surgery is a one-stop solution for surgeons to provide an extensive product portfolio addressing all their surgical needs & enables them to provide better patient outcomes in hernia surgery. To know more about the meshes & other products from Meril Endo Surgery, please click on the link Meril Endosurgery