general-surgery

Hernia

Background:

Broadly speaking, hernias are caused by a weakness or defect in the abdominal muscle, leading to a visible bulge (herniation). It can be brought on by heavy lifting or excessive straining but some times, the cause is unclear. Hernias tend to enlarge over time and can cause symptoms of discomfort or pain, especially when straining, lifting weights or exercising. Uncommonly, a hernia can sometimes protrude and becomes incarcerated i.e. not reducible, resulting in a tense tender lump. Strangulation of bowel within the hernia may result. Patients are advised to seek urgent medical attention if a hernia becomes painful and irreducible, as this represents a surgical emergency.

There are different types of hernia in the abdomen. The more common types are Inguinal, Umbilical and Incisional Hernia. Other less common types include femoral, epigastric and spigelian hernia.

 

Inguinal Hernia

This refers to a Hernia that occurs in the groin (Inguinal region) and is the commonest type of abdominal hernia. An inguinal hernia tends to gradually enlarge, can sometimes occur on both sides and often leads to discomfort on exercise or exertion. The surgery to repair an inguinal hernia is often performed under general anaesthetic. The hernia is reduced and a synthetic mesh made of polypropylene is secured in place to strengthen the area of weakness. The use of mesh is standard modern practice and provides the strongest repair possible.

Inguinal Hernia Mesh Repair can be performed either using a standard open method or Laparoscopic (key-hole) approach. Studies have shown that both methods have comparable long term results. With a unilateral uncomplicated inguinal hernia, a standard open approach is straightforward and remains the most common technique used in New Zealand. This is performed as a day stay procedure and has a rapid period of recovery and return to work. The Laparoscopic approach is advantageous in two situations: 1.) In patients with bilateral Inguinal hernias 2.) In patients with a hernia recurrence after a previous hernia surgery. There are pros and cons in both techniques and the Laparoscopic approach may not be suitable for patients who have had previous abdominal/pelvic surgery.

After surgery, the patient will have a water-proof dressing which can be removed after 7 days. Steristrips on the wound can be left on for another week. There are no stitches to remove (they are dissolvable). The wound should be kept clean and dry. The patient is advised to take pain-killers regularly for the first 3 – 4 days and is encouraged to gently mobilize at home. Excessive exertion or lifting heavy load should be avoided in the first week, with gradual increase in activity on the 2nd week. The patient can return to work as early as the 2nd week, depending on type of work and comfort level. Normal level of activity can usually be expected after 4 weeks.

Peter Chin is trained in both the open and laparoscopic technique for Inguinal Hernia Repair and will be happy to discuss the option that is most suitable for your condition.

 

Umbilical Hernia

This is a hernia that occurs in the umbilical (belly-button) area. The defect is usually small ( 1 - 2 cm) but can gradually enlarge over time and become uncomfortable. An Umbilical Hernia repair is performed as a day stay procedure. A small incision is made, the hernia is reduced and the defect repaired either with sutures alone or in larger defects, with a synthetic mesh. The post-operative care is similar to an inguinal hernia repair (see above).

 

Incisional Hernia

This is a hernia resulting from a weakness in the abdominal wall muscle due to previous abdominal surgery. This type of hernia is usually found along the scar from a previous surgery. As a result, it can range in size from a small defect to a hernia that extends along the whole length of the abdominal wound. Surgical repair involves inserting a mesh to strengthen the area of weakness. Depending on the size of the hernia, surgical repair can range from a straightforward day stay procedure for smaller hernias to a large complex procedure requiring several days of hospital stay. Incisional Hernia repair can be performed as a standard open procedure or using the laparoscopic approach. There are pros and cons associated with either technique. Peter Chin is trained in both the open and laparoscopic approach and will be happy to advice on the most suitable technique for your condition.

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