Hernias

What is a hernia?

A hernia happens when an internal part of the body – either bowel, bladder or simply fat – bulges out from a weakness zone or a defect of the internal part of the abdominal wall.

Are there different types of hernia?

A hernia can arise through any weakness zone, either congenital or acquired. The most common hernias are in the groins (inguinal and femoral hernias). Other hernias can come through the belly button (umbilical hernia), the fascia covering the abdominal muscles (epigastric and Spigelian hernias), the lumbar triangle (lumbar hernia), the obturator canal (obturator hernia) and even through a non perfectly healed surgical incision (incisional hernia). In a hernia, the herniated viscus or fat does not actually come out from the skin, but it is still covered by skin.

There are also a number of internal hernias, meaning the passage of some internal organ through a defect or a hole within the abdominal cavity. These are to be considered separately as their symptoms and consequences are completely different from those of common wall hernias.

Why do I have a hernia?

Anyone can get a hernia if he or she has a weakness zone of his/her abdominal wall. The increased abdominal pressure – as with pregnancy, abdominal straining, physical effort, coughing – does the rest, pushing abdominal content out. It is not a single physical effort that actually causes the hernia, but it represents only the straw that broke the camel’s back.

What are the symptoms of a hernia?

In the very most of cases, the only symptom of a hernia is a non-tender lump. In some patients this lump can become occasionally painful and can reduce the usual physical mobility as the hernia can get compressed by the moving muscles. Very often, the lump comes and goes depending on the position of the patient, usually it disappears completely when the patient lays flat, but sometimes the content gets blocked into the hernia and becomes non-reducible. Rarely, contraction of muscles and scar tissue around a hernia can strangulate it, that is create a critical compression on the blood vessels leading to the herniated tissue, causing ischaemia of the herniated viscus, with stabbing pain, signs of infection and sometimes vomit and difficulty in passing wind and stool; in this case the hernia becomes firm and tender and warrants an immediate visit to A&E.

How should a hernia be investigated?

Usually, no investigations are needed to diagnose a hernia. Any practitioner – either surgeon or physician – should be able to see and evaluate a hernia. However, sometimes an ultrasound scan or – very rarely – a magnetic resonance imaging can be necessary to confirm the presence of a hernia, in case of symptoms suggestive of hernia but with no visible lump.

How can a hernia be cured?

The only possible treatment of a hernia is surgery. With surgery, the hernia content is pushed back in the abdomen and the defect is closed with stitches or reinforced with an artificial mesh. Surgery can be performed traditionally, with an incision usually just above the lump, or by laparoscopy or keyhole surgery, with three or four small holes into the abdomen. Usually, hernia surgery can be performed as an outpatient or day case procedure, where patients come to the hospital few hours before surgery and are discharged few hours afterwards. They are allowed to walk immediately after recovering from anaesthesia and to restart their normal activity gradually within a couple of weeks. Patients who cannot or don’t want to be operated, can reduce the risk of strangulation by using a truss which keeps the hernia pushed back. The choice to offer an operation for a hernia depends on factors pertaining to the hernia itself (risk of strangulation, symptoms, limitation of everyday life) and to the patient (past medical history, level of activity and autonomy). Ultimately, the choice is up to the patient, after the doctor has informed him or her of pros and cons of hernia surgery in that particular case.

Is it possible to have complications after hernia surgery?

Of course it is! Any surgery bears the risk of complications. Usually, hernia surgery is straightforward and uncomplicated, but in a very small percentage of cases a complication can occur. The most frequent complication is the formation of a collection of clear fluid, called seroma, as a reaction of the tissues to the presence of the foreign body represented by the mesh. Very rarely, this collection can get infected, creating an abscess with pus and general signs of inflammation. One possible complication of hernia surgery is chronic pain, due to nerve entrapment into scar tissue or the mesh itself, and this may need further treatment to be treated. Very rarely, other awful complications can happen, as injury of the bowel or the testis, but they are almost anecdotal.

If I had my hernia operated, can it recur?

Yes it can. The average general risk of recurrence is around 10%, irrespective of the technique used. Avoiding a too early return to the usual physical activity helps in reducing the risk of recurrence after surgery.

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