These weaknesses allow an opening to occur causing the inner lining of the cavity to protrude through it and form a sac. A hernia often occurs as a result of obesity, pregnancy, heavy lifting, chronic coughing, constipation and straining to pass stools.
Types of Hernia
- Inguinal Hernia (Groin Hernia)
- Umbilical Hernia
- Epigastric Hernia
- Incisional Hernia
- Fermoral Hernia
- Hiatus Hernia
- Sportsman’s Hernia (Gilmore’s Groin)
Inguinal hernia is the name given to a hernia that occurs in the groin. This is the most common type of hernia making up 80% of cases. Although inguinal hernias mainly occur in men, women can also develop this type of hernia. There are two different types of inguinal hernia; Direct and Indirect.
- The most common presentation for an Inguinal Hernia is the appearance of a lump in the groin that may descend into the scrotum.
- The lump usually becomes more prominent on standing and disappears when lying down.
- Patients also often complain of pain and discomfort in the area.
The most serious complication of an Inguinal Hernia is Strangulation. This is when the hernia gets stuck through the opening and cannot go back. At this point the patient will present with severe acute pain and a very tender lump in the groin. If not treated urgently the intestine stuck in the hernia will lose its blood supply and die. This is a life threatening complication and should be treated as an emergency.
The risk of strangulation is higher in Indirect Hernias because of the narrower opening. Differentiation between Direct and Indirect Hernias is not easy and requires careful examination by a specialist.
Most of the inguinal hernias are diagnosed by the presence of symptoms and a lump in the groin on clinical examination. Hernia Specialists usually do not ask for any investigations like ultrasounds and CT Scans during diagnosis, however in difficult cases where a clinical diagnosis is not possible these procedures can be helpful.
Surgical and Non-Surgical Treatment
Once a hernia has developed it will not go away and the only treatment is surgery to close the opening. In patients who are not fit for an operation a Truss (hernia belt) can be worn to keep the hernia reduced and control symptoms however they are relatively difficult to use and not always effective.
Surgical repair of a hernia consists of closing the Hernia opening and strengthening the abdominal wall either by sutures or mesh. There are two main ways of carrying out a hernia repair either by a Conventional Open Operation or a Laparoscopic Hernia Operation
Conventional Open Operation
The Hernia is repaired through a 7-8cm sized incision in the groin. The sac is reduced and the defect in the wall is repaired by placing a synthetic mesh over it. This operation can be done under Local or Regional Anaesthesia. The patient usually goes home the same day and most of the patients would have recovered from the operation within 6 weeks of the procedure.
Laparoscopic Hernia Repair
This is the latest method of hernia repair. In laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient's belly button. Two other small cuts are made (each no larger than the diameter of pencil) in the lower abdomen. The hernia defect is reinforced with a 'mesh' (synthetic material made from the same material that stitches are made from) and secured in position with titanium tacks.
The advantages of Laparoscopic repairs are:
- Less pain
- Quicker Recovery
- Ability to repair both sides of hernia through the same incision
- Smaller Scarring
I recommend Laparoscopic Hernia Operations in all patients who have Hernias on both sides, those who have developed recurrent hernias and young, fit patients who have no extra risk from general anaesthesia.
I have been doing Laparoscopic Hernia Repairs for over 18 years. I do TAPP (Trans Abdominal Pre Peritonial) Repair. I have excellent results and feel that Laparoscopic Repair is a superb operation and should be offered wherever possible.
Frequently Asked Questions
Who can have this operation?
Most of the patients who have an inguinal hernia can have an operation for it. In elderly unfit patients if an operation is required it can be done under local anaesthesia.
Is the operation done by Keyhole?
Yes, I recommend Laparoscopic Hernia Operations (Keyhole) in all patients who have Hernias on both sides, those who have developed recurrent hernias and young, fit patients who have no extra risk from general anaesthesia.
How long will I be in hospital?
The operation is done as a day case for most of the patients and so they will be able to return home that same day.
Will there be a lot of pain after the operation?
Pain is minimum after Keyhole operations however you will be given painkillers to reduce any discomfort. The majority of patients pain will be controlled with minimal medication within one to two days.
How long will it be before I can drive again?
The patient is usually advised not to drive within the first week. If pain and discomfort is not a problem within the second week of post-op then you should be able to drive. Long distance and prolonged driving should be avoided during the first few weeks.
When can I return to work?
In most cases you should be able to return to work with in 4 weeks after the procedure unless the work requires heavy lifting and strenuous activity, in those situations a slow return to work is advised and heavy lifting should be avoided for 6-8 weeks. Laparoscopic Hernia patients could be back to doing sedentary work within two weeks of the operation.
Umbilical hernias occur in the region of umbilicus. The umbilicus is a potentially weak point in the abdomen wall from birth and is a common site where hernias occur. The hernia presents as a lump at or around navel area that could give pain and becomes tender to touch.
Small and easily reducible Umbilical Hernias can be left untreated otherwise the treatment is surgical repair. Surgery is usually done through a small incision below the umbilicus and the hernia is repaired with Nylon suture or placement of mesh.
Umbilical Operations can also be performed using the Keyhole Technique, during which a mesh is placed from inside the abdominal cavity to cover the hernia opening. However I only recommend the Keyhole technique in patients who have a large Umbilical hernia or are obese.
The patient usually goes home the same day and most of the patients would have recovered from the operation within 4 weeks of the procedure.
Epigastric hernias occur between the lower part of the breastbone and the naval and is caused by a weakness or opening in the fibrous tissue of the abdomen. This type of hernia usually consists of fatty tissue and rarely contains intestinal tissue. Although generally small in size (no bigger than a golf ball), epigastric hernias can easily become pinched in their small area, sometimes causing a great deal of pain.
The patient again usually presents with a lump and surgical repair is the only way to achieve a cure. This operation is usually not done as a Laparoscopic Operation. The operation is done through a small incision of the lump and the defect is closed using either a suture or mesh.
The patient usually goes home the same day and most of the patients would have recovered from the operation within 2-3 weeks of the procedure.
This is a hernia that occurs through a previous surgical incision and usually presents as a lump or bulge along a scar. It gradually increases in size and can produce pain due to the possibility of strangulation.
Treatment is by operation that can be done by Open Surgery or Laparoscopic technique. Again mesh is used to strengthen the abdominal wall. A large incisional hernia may be difficult to repair and may require a major operation.
Femoral hernias are similar to inguinal hernias. The femoral hernia occurs when abdominal contents are forced through the "femoral canal". Typically this type of hernia forms near the crease of leg in the abdominal region, but in an area relatively lower than the more common inguinal hernia. The two types of hernias are often too difficult to tell apart in diagnosis, which is why a hernia specialist is often required to confirm diagnosis.
Femoral hernias are more likely to become incarcerated or strangulated because of their location, which is why repair is strongly advised upon diagnosis of this type of hernia.
Femoral hernias are rare, and mostly seen in middle-aged and elderly obese women who have given birth several times.
Hiatus hernia occurs when part of the stomach pushes itself through an opening in the diaphragm.
There are two types of hiatus hernia.
Sliding hiatus hernia: This is the commonest type of hernia accounting for 85% of cases. In this condition the lower part of the oesophagus slides along with upper stomach through the hiatus in to the chest. Sliding hiatus hernia is associated with the development of symptom of gastroesophgeal reflux disease (GORD) and its management is same as that of GORD.
Rolling hiatus hernia: In this part or whole of the stomach passes through the hiatal opening in to the chest. Patient can experience pain and vomiting and this type of hernia have the risk of serious complication of strangulation of the herniated stomach. Operation is necessary to treat a rolling hiatus hernia if there is risk of strangulation.
Sportsman’s Hernia (Gilmore's groin)
This is the name given to condition when young, active men complains of chronic groin pain. This name isa misnomer. There is no hernia and it is believed that pain is due to the injury to the muscles which are attached to the pubic tubercle. This condition is common in sportsmen.
Patient usually complains of pain in the groin which started after a game or strenuous activity and has progressively gone worse. Pain is worse on coughing, sneezing and squeezing the groin together.
Many patient gives a history of the pain disappearing after a period of rest and not taking part in sports, only to reappear once they started playing again.
This is a debilitating condition affecting the quality of life and occasionally lively hood of young otherwise fit people. This commonly occurs in professional athletes like footballers, hokey and cricket players.
Management of this chronic condition is difficult.
To make a correct diagnosis and exclude any others underlying disease patient may require to have investigations like X-ray, ultra sound scan and MRI.
Treatment requires a multidisciplinary approach. Patient is advised to have a period of rest, is given painkillers to take and have physiotherapy.
If these measure don't work and symptoms are sever and effect patient's quality of life then surgery can be considered.
I perform laparoscopic (keyhole) operation. During this through small incision at umbilicus peritoneal cavity is entered and I place a large mesh is placed over the pubic tubercle and adjacent area. Patient go home same day and most patient return to normal activity in 2 to 3 weeks.
This treatment is effective and in a recent randomised trial it was found to be effective in curing patient of pain and return to work in 88% of cases.