Hernia

Introduction

A hernia is a protrusion of an organ or structure into a sac formed out of lining of the space that contains the structure, which comes through a hole or weak area in the wall of a muscle, tissue, or membrane that normally holds an organ in place. Hernias are more common in in certain parts of the body such as the abdomen, groin and upper thigh area, and belly button area. They also can occur in any place where you have had an incision from surgery.

Hernia Types

There are different types of hernias based on their location. The most common types are listed below:

• Inguinal Hernia – Appears as a bulge in the groin or scrotum, occurring more commonly in male than female.
• Femoral Hernia – A femoral hernia appears as a bulge in the upper thigh, is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the “femoral canal”(a tube-shaped passage at the top of the front of the thigh). This type of hernia tends to occur in older people and is more common in female than in male.
• Hiatus Hernia – A hiatus hernia is when part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen.
• Incisional Hernia – Hernia through a previous scar.
• Umbilical Hernia – Umbilical hernia is a small bulge around the umbilicus (belly button). An umbilical hernia in an infant is caused by the incomplete closure of the muscles around the umbilicus. Hernia will not get better by itself and may need to be treated surgically as they have a high risk of becoming strangulated. A hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital. The operation may be performed as an “open” or “keyhole” (laparoscopic) surgery. 
• Spigelian Hernia - Hernia through the junction between the rectus muscle and the external oblique muscle. This type is hernia is rare, and usually occurs in the part of the line below the umbilicus.

Open hernia repair

A large incision is made on the groin (abdomen) and the bulge is pushed back into place and a mesh is placed to cover the weak area where the hernia was.

Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the abdomen through a small incision. The laparoscope is a small fibro-optic viewing instrument attached with a tiny lens, light source and video camera.

Indications and contraindications 

Indications for laparoscopic hernia repair over open repair may include recurrent hernias, bilateral hernias, and the need for earlier return to full activities.

Contraindications specific to laparoscopic hernia surgery include inability to tolerate general anaesthesia.

Medical conditions including upper respiratory tract or skin infection and poorly controlled diabetes mellitus should be fully addressed and the surgery should be delayed accordingly.

Advantages over an open surgery

• Less post-operative pain with smaller incisions and faster recovery.
• No further incisions required for patients with hernias in both groins (bilateral hernia).
• Ideal method for patients with recurrent hernias after previous surgery.
• Early discharge from hospital.
• Earlier return to work.

Disadvantages over open operation

• General anaesthesia is required.
• Expensive.
• Unproven recurrence rate in the very long term.

Laparoscopic surgery is performed in a hospital operating room under general anaesthesia. The television camera attached to the laparoscope displays the image of the abdominal cavity on a television screen. The surgeon makes three small incisions over the abdomen to insert the balloon dissector and trocars (keyholes). A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision. Once the trocars (key holes) are placed, the keyhole instruments are then inserted to repair the hernia. A sheet of mesh is inserted in through the top keyhole and positioned and fixed it in the abdominal wall to reinforce the repair and help prevent recurrent hernias. After completion of the repair the CO2 gas is evacuated and the trocars are removed and the tiny incisions are closed and dressed with a sterile bandage.

Specific complications of laparoscopic hernia surgery may include local discomfort and stiffness, infection, damage to nerves and blood vessels, bruising, blood clots, wound irritation and urinary retention.

Postoperative Guidelines

• Pain medication will be provided and should be taken as directed.
• Remove the bandage after 24 hours.
• Swelling in the groin, at the site of hernia may occur due to serum accumulation in the cavity left by reducing the hernial sac.
• Bruising usually appears in the genital area, which is not painful and disappears over 1-2 weeks.
• You are able to drive and resume normal activities when comfortable unless otherwise instructed.
• Make a follow up visit 7 to 10 days after surgery to monitor your progress.