HERNIAS
A hernia is basically a protrusion of tissue or organ(s) into another space through a weakness in the wall that usually holds them in place. In the abdominal region, most common hernias are abdominal wall hernias and the hiatus hernia. In most cases, hernias are not immediately life-threatening, but they can cause discomfort and lead to serious complications if left untreated.
INGUINAL HERNIAS AND OTHER HERNIAS OF THE ABDOMINAL WALL
Hernias are named according to where they occur in the body. Inguinal and femoral hernias both appear as a bulge in the groin or lower abdomen. An inguinal hernia passes through the inguinal canal and is more common in men than in women, whereas a femoral hernia passes through the femoral canal and is more common in women and with age. An umbilical hernia causes a small bulge around the umbilicus (belly button) and an incisional hernia causes a bulge at the site of a previous operation. Hernias can contain fat, a loop of bowel, or other abdominal content(s).
Hernia symptoms & causes
Hernias may be asymptomatic, or accompanied by discomfort. A loop of bowel that's trapped in a hernia can lead to a bowel obstruction, causing nausea and vomiting. The content(s) of a hernia can also become strangulated when their blood supply gets cut off, resulting in pain and redness around the hernia site. These are considered medical emergencies.
Risk factors for hernias are conditions that that weaken the abdominal wall or increase abdominal pressure such as smoking, heavy lifting, aging, chronic cough or straining, and obesity. Some people are born with an inherent weakness the abdominal wall, predisposing them to hernias.
Laparoscopic hernia repair
Basically, a hernia repair involves reducing the contents of the hernia back where they belong, closing the defect and reinforcing the wall with mesh.
​
Evidence has shown that keyhole (laparoscopic) hernia repairs offer superior patient outcomes - shorter hospital stay, less pain, less infection, and earlier return to work. However, certain conditions make keyhole hernia repairs more challenging. Large hernias, previous prostate, bladder, or pelvic surgery all make laparoscopic access more difficult, and open surgery tends to be a better option in these contexts.
Non-surgical management of hernias
Hernias do not typically get better on their own. A hernia repair is indicated when symptoms start to bother you, or when the hernia is at high risk of causing complications such as bowel obstruction or strangulation. All femoral hernias should be referred for surgery due to its higher risk of strangulation.
A wait-and-review approach may be taken for hernias with no or minimal symptoms and hernias without high-risk features, however, hernias tend to larger over time and 75% will require surgery within ten years.
A hernia belt or truss may be used to help manage symptoms, but many patients find them cumbersome and often difficult to position effectively.
Risks of hernia repair
Hernia repairs are widely performed and considered "bread and butter" surgeries for general surgeons. In addition to general surgical and anaesthetic risks, risks specific to hernia repairs include wound infections (3%) and recurrence (1-2% over 5 years for inguinal hernias). Bleeding, chronic postoperative pain as well as damage to internal organs and nerves are uncommon but nevertheless possible.
Recovery after hernia repair
After an elective (non-emergency) hernia repair, most patients go home on same day or the day after. All patients should avoid heavy lifting for 4-6 weeks after surgery. On average, patients feel well enough to return to work and drive in about a week. Driving should not be attempted until you feel comfortable making an emergency stop and looking over your shoulder.
​
It is not uncommon to experience pain, bruising and swelling after a hernia repair. Most of the time, this is manageable with pain medications and simple measures such as modifying the way you get up from a lying position and tighter fitting underwear.
HIATUS HERNIA
A hiatus hernia is a protrusion of abdominal contents, usually part of the stomach, through the diaphragm and up into the chest cavity. It does not manifest in an external bulge but in reflux, heartburn, difficulty swallowing. More subtly, it can present as anaemia due to irritation and ulceration of the herniated stomach. In severe cases, several abdominal organs protrude into the chest. The stomach can twist on itself (volvulus) and cause a complete obstruction, which is a medical emergency.
Hiatus hernia repair and associated risks
A repair involves reducing the herniated contents back into the abdomen, closing the defect in the diaphragm, and wrapping the stomach around the oesophagus (gullet) to create an anti-reflux valve. This also provides bulk to reduce the chances of it slipping back into the chest. This is called a fundoplication. Specific risks of a hiatus hernia repair include difficulty swallowing and recurrence (3-10% patients experience symptomatic recurrence requiring reoperation). Rarely, damage to the oesophagus, stomach, or the nerves that supply the stomach may occur.
Recovery after hiatus hernia repair
Patients typically spend a few days in hospital after a hiatus hernia repair. Due to tightening of the oesophagus involved during surgery, there will be a gradual, stepwise reintroduction of diet, from liquid to puree to soft to normal diet. An in-hospital dietitian will provide more detailed advice prior to discharge
***The content on this website or linked web pages are intended for educational purposes only and should not be relied on to make healthcare decisions in the absence of a consultation with a healthcare professional