What is a hernia?
Hernia is an abnormal protrusion of abdominal contents through a weakness in the abdominal wall. The outcome of this process is a lump, which can contain fat or bowel contents or both, that initially pops in and out of the weak area. This is called a reducible hernia. This can cause intermittent pain and discomfort or may be asymptomatic.
Eventually (at a rate of 1% per year) it may progress to a symptomatic hernia or an incarcerated hernia, where the lump and its contents are no longer able to pop back into the abdomen and persist stuck in the weak point of the abdomen. At this point it may become persistently painful and swell and really interfere with normal activities requiring an urgent visit to the hospital for emergent surgery to fix it.
A special case of incarcerated hernia is when it contains bowel within it. This can then progress to what’s called a strangulated hernia, in which the bowel and its blood supply are constricted tightly and no more blood is coming to the constricted segment leading to necrosis of bowel, which a very serious problem, usually requiring resection of the diseased segment of the bowel.
Hernias can occur in multiple locations around the abdominal wall, however the most common sites are in the groin with inguinal and femoral hernias and in the front abdominal wall with umbilical and paraumbilical, epigastric and incisional hernias being the most common.
There are also rare types of hernias such as spigelian hernias, lumbar and obturator hernias, as well as internal hernias and diaphragmatic hernias including hiatus hernias.
There are 2 main approaches to treating hernias. Both include placement of a mesh (a synthetic or biological material) to support the weak area affected. The differences are how that mesh is placed in its position and also in what position it actually is placed, which can affect the result as well.
The approaches are:
- Open (or traditional) surgery is the most common approach and has been shown to be safe, effective and have low recurrence rates.
- Laparoscopic (or Key-hole) surgery is a different method, which has equivalent results to open surgery with an advantage or quicker recovery and return to work and normal activities.
Both have their place depending on the clinical situation but Laparoscopic approach is our preferred technique and is the standard of care both in initial and revisional hernia surgery.
During your consultation, after a thorough assessment we will be able to advise you on the appropriate further investigation or procedure choice and discuss the pros and cons of these.