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hernia

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  • A hernia occurs when the intestines or any structure protrudes through the weakness or defect in the abdominal wall

  • The abdominal wall or groin regions are the common sites of hernia. They can also occur inside the abdomen, called as internal hernia

  • Hernia can be congenital or acquired. Hernias are classified based on the anatomical location

  • Hernias are more common in males than females

  • Almost all hernias require a surgical repair, as spontaneous closure of defect is very rare except infantile umbilical hernia where defect closure can occur up to 4-5 years of age

  • With the improvements in surgical techniques and availability of better instruments now a days hernia surgeries are increasingly done by laparoscopic methods

What is congenital hernia?

  • Hernia which are present since birth Eg.- infantile umbilical hernia

What is acquired hernia?

  • Hernia which develops any time after birth (which are not present at birth)

Is hernia a tumor?

  • No. Hernia is not a tumor. It is a bulge that looks like a tumor

What is external hernia?

  • Hernia bulge which can be seen from outside

  • For example- all abdominal wall hernias

What is internal hernia?

  • Hernia which occurs inside the abdomen (can not be seen from outside)

  • For example- Diaphragmatic hernia, para-duodenal hernia, hiatal hernia etc.

Why does anyone develop hernia?

  • Hernia occurs whenever there is weakness or defect in the wall

  • So, any conditions which weakens or put pressure on the abdominal wall for a prolonged period may lead to hernia

    • Straining on the toilet (Chronic constipation)

    • Chronic cough

    • Enlarged prostate / Straining to urinate

    • Obesity

    • Ascites / Abdominal fluid

    • Pregnancy

    • Lifting heavy weights

    • Poor nutrition

    • Smoking 

How to prevent hernia ?

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  • Avoid smoking

  • Healthy diet and regular exercises to maintain ideal body weight

  • Plenty of liquids, fruits, vegetables and whole grains to avoid constipation

  • Early treatment of persistent cough/constipation/prostate problems

  • Avoid lifting weights that are too heavy

What is incisional hernia?

  • Hernia which occurs through the site or scar of previous surgery

What is traumatic hernia?

  • Hernia which occurs as a result of trauma

  • For example- blunt abdominal trauma, sharp injury to abdomen etc.

What is recurrent hernia?

  • Hernia which recurs after previous hernia surgery

What are the types of hernias depending on the site?

  • Hernias can be classified according to the site of occurrence

    • Epigastric hernia- Epigastrium

    • Umbilical hernia - Through umbilicus

    • Para- umbilical hernia - around the umbilicus

    • Groin hernias

      • Inguinal hernia - through inguinal canal

      • Femoral hernia - through femoral canal

    • Spigelian hernia- through spigelian fascia​

    • Lumabar hernia - through lumbar region

    • Obturator hernia - through obturator canal

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What are the symptoms of hernia?

  • Swelling / bulge (increases after straining, standing, cough etc.)

  • Pain

  • Fever, vomiting and constipation in case of complicated hernia

How hernia is diagnosed?

  • Hernia is mainly diagnosed by clinical examination

  • Ultrasonography or CT scan are required in some cases

How hernia is treated?

  • By surgery (with ot without mesh)

Can hernia be treated with medications?

  • No. Surgery is the option

Can hernia surgery be done laparoscopically?

  • Yes. Hernia can be repaired by both open and laparoscopic surgery

What are the different types of hernia surgery/repair?

  • Herniotomy - Only sac containing the hernia is excised ( eg.- congenital hernia in infants and children)

  • Herniorrhaphy - In addition to excision of sac, wall is strenghtened by tissue aproximation

  • Hernioplasty (Meshplasty) - sac excision + wall strenghthening by using a mesh 

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My doctor told me that I have hernia. when should I undergo surgery?

  • In complicated hernia surgery should be done immediately

  • In non complicated hernia it should be done as early as possible to prevent complications

What are the precautions I should take after hernia surgery?

  • To avoid any manoeuvre that increases intra abdominal pressure for at least 3 to 6 months

  • For example- Lifting heavy weight, chronic cough, chronic constipation etc.

What are the advantages & disadvantages of laparoscopic hernia surgery?

  • Advantages

    • Cosmetically better especially in young patients

    • Less pain

    • Less wound infection

    • Early return to work

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Disadvantages

  • Costlier than open surgery

  • Need for experienced laparoscopic surgeon with adequate skills

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What are the commonly done laparoscopic hernia surgeries?

For groin /inguinal hernias

  • TEP - Total Extra Peritoneal repair

  • TAPP - Trans Abdominal Pre Peritoneal repair

For abdominal wall hernias

  • IPOM & IPOM plus - Intra peritoneal Onlay Mesh plasty etc.

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