All that you need to know about hernia

DR PRACHI MAHAJAN, MS, FRCS, FMAS, FIAGES
(Consultant, Breast and Minimal Access Surgery), Orange City Hospital and Research Centre, Nagpur

WHAT IS A HERNIA?

A hernia is the protrusion of an internal viscus, most commonly the small intestine, through a defect in muscles. In other words, it causes a SWELLING or BULGE through the muscles overlying it.


The commonest types of hernias are :
INGUINAL/GROIN hernia:

This is common in males, causes a bulge in the groin, becomes more prominent on standing, coughing, straining. In the early stages, a hernia may disappear on lying down. If left untreated, it increases in size and needs to be manually pushed inside (reducible hernia). Later, it becomes too large and as the hernial sac gets thickened and the contents become adherent, a hernia becomes IRREDUCIBLE.

A loop of small intestine contained in the hernia may get trapped in the hernia and even become OBSTRUCTED or GANGRENOUS. Such an event demands emergency surgical treatment, hence inguinal hernias should be repaired surgically as soon as they are diagnosed.

INCISIONAL / VENTRAL HERNIA:

This type of hernia commonly occurs through a previous surgical scar due to various reasons. A surgical scar may be weakened because of infection in the post operative period, sepsis, poor nutrition, obesity, diabetes, other hormonal factors, chronic strain such as due to asthma, chronic cough or constipation. This may lead to poor healing and formation of a weak scar. Combined with poor abdominal muscle tone, the muscles move apart and the visceral contents protrude through the defect. Ventral hernias cause asymmetric bulges in the abdominal wall which may look unsightly.

PARAUMBILICAL HERNIA:
This is a type of hernia that protrudes through the umbilicus ( belly button). Being a small ring like gap, these hernias are more prone to get obstructed.

TREATMENT OF HERNIA:
The treatment of any type of hernia is always surgical repair. Depending upon the type, site and size of hernia, the surgical technique varies. The basic principles of repair, however, are the same.

They include,

  • Reduction of the contents
  • Separation and/or excision of the sac
  • Approximating the boundaries of the defect
  • Repair and reinforcement using a synthetic mesh

LAPAROSCOPIC OR OPEN REPAIR OR COMBINED (HYBRID) REPAIR may be performed, which is decided after taking all patient factors into consideration. These may be intra peritoneal or extraperitoneal repairs and different types of meshes and fixation devices are available. With the recent development of Abdominal Wall Reconstruction (AWR) as a separate entity, newer and newer procedures are being added such as eTEP, TARM procedure, TAPP, to name a few and they have facilitated repair of very large hernias too.

THE AIM OF HERNIA SURGERY IS TO GIVE THE PATIENT A STABLE REPAIR, PREVENT A RECURRENCE, COSMESIS AND ADD TO HIS/HER TISSUE STRENGTH DEPENDING UPON THE PATIENT’S OCCUPATION.