When a part of a structure inside the belly (abdominal cavity) protrudes out though the wall of the abdomen, doctors call the condition a hernia.
Mostly people are aware of hernias on the outside the belly wall (external hernias), but there are hernia that occur inside the abdominal cavity and are called internal hernias such as hiatus hernia.
- The external hernias are the commonest
- They usually come to notice when a lump appears at the site or
- Person notices discomfort/pain at the site of hernia when straining
The main danger is that upto 30% of hernias can stragulate and become an emergency in the life time of the patient
Types of hernia : the commonest are:
- Groin hernia (inguinal)
- Around belly button (umbilical or para umbilical)
- Femoral hernia
- Incisional (through a previous scar in the belly)
- they can be present at birth or appear later in life
- they are best seen by a surgeon and sorted out as soon as possible to avoid further problem
- most of the patient are concerned about having a general anaesthetic
Almost 90% of hernias can be repaired under local anaesthetic (by freezing the local area) and one can literally walk away from the hospital in a few hours.
You are free to walk around, go up and down the stairs soon after the operation, without any risk
I advise patients not to lift anything heavy for 6 weeks, to allow the mesh to incorporate in the body tissues.
It is a general practice to use a nylon/prolene mesh to secure a sound tension free repair of hernias in my practice, i do not put any skin stitches. They are all dissolving and one does not need to have the stitches taken out. The dressings i use allow you to have a shower the next day.
- How do i know i have one
- Hernia presenting as a lump in the groin
- It may be uncomfortable/painful or painless
- It may disappear when you lie down or appear when straining
If you notice such a lump, it is best to see your doctor and get it sorted, as it will never disappear. It may not be causing symptoms today, but may do so in future. It is best to remember, one is younger and fitter today that they will be when older.
Almost 90% of patients can have the operation as a day case under local anaesthetic and walk out of the hospital in less than 2-3 hours.
Patients with groin hernias on both sides or those where hernia has come back after a previous operation (recurrent), i recommend that they are repired by key hole surgery(laparoscopic surgery)
Key hole surgery can only be done under general anaesthesia
Umbilical hernia/ para-umbilical hernia:
- Hernia around the belly button
- Babies are connected to their mother at the umbilicus. The defect usually closes at or soon after birth, but in some children it does not and can result in a hernia.
- In vast majority of babies this defect closes naturally by the age of 2 years.
- However chronic cough, constipation, lifting heavy weights, pregnancy can precipitate the herniation.
- As the defect is small, it carries more risk of strangulation.
- Best repaired under local anaesthesia or general anaesthesia as a day case
- If it is recurrent, one can have it done by key hole surgery
- In the groin, deep on the inside of groin crease on top of front of thigh
- Usually in ladies and particularly those who have lost a lot of weight, are heavy smoker or suffer from breathing problems
- The opening through which the hernia occurs is called femoral canal
- It is a very small opening and this hernia carries a very high risk of strangulation
- This hernia should be repaired as an urgency to avoid an emergency
How do i know if i have one:
Look for a small plum size swelling in the groin crease close to the genitalia.
What to do?
If you notice such as a swelling, please see you doctor as an urgency and seek a surgeon’s opinion.
It is not an emergency, but can very easily become one, if ignored.
An operation, which can be done under local anaesthetic as a day case
You can return to normal activity in 3-4 hours
If you have noticed a lump and it becomes tender, increases in size, you have vomiting and or your belly swells up, please go to the nearest accidents and emergency unit as you need urgent medical attention and very likely an operation.
If you have had any previous operation through the belly wall e.g caesarean section, hysterectomy, resection of bowel, perforated ulcer etc, sometimes the scar becomes week and loops of bowel can bulge out through it causing a bump which can be uncomfortable, painless or painful. It usually becomes smaller when one lies down. It can give rise to indigestion.
These hernias are best repaired using key hole surgery (laparoscopic surgery) under general anaesthesia. It is successful in a significant majority of patients giving excellent results, less pain and quick recovery.
You need to be in hospital for 1-2 nights and are mobile within a few hours after the operation. Total recovery can take upto 1-2 weeks, depending on your general health.
- Some patients develop a small lump between the belly button and the midline of ribcage.
- It is usually pain less, but can become noticeable, particularly in thinner people.
- It is associated with indigestion by some patients
- It needs a small operation to rectify and can be done as a day case under local anaesthesia or general anaesthesia.