What you need to know about Hernias?
A hernia is a hole in the abdominal muscle because of which abdominal contents like gut and fat come out and can be felt below the skin.
Most patients present with a lump in their abdomen and groins. It may occur at the site of a previous surgery.
It may present with symptoms such as lump, pain, and discomfort. Sometimes, the contents like gut and fat can get stuck leading to pain, vomiting, abdominal distension and constipation.
Many hernias can happen with no discernible reason but some patients may have features of chronic cough, constipation and straining for urination. Some are caused by a weak scar from a previous surgery. This particular condition is called incisional hernia and requires more detailed evaluation before treating them. Obesity is also an important cause of hernia.
Many hernias may be asymptomatic but some patients may have pain on standing and physical activity. Sometimes, the gut may get stuck and their blood supply may be cut off leading to a dangerous condition called strangulation. These generally need emergency surgery and may be a potentially dangerous condition.
A complex hernia is the one that is very large in size, or located in a difficult site such as close to the ribs or hip bones. Failed previous surgeries also make it complex. Hernias can be complex when it is associated with poor patient factors such as obesity and diabetes.
Most hernias will need surgery. The general principle is to repair the defect with a mesh – a flat piece of plastic net compatible with human tissue. Some hernias can be left without operation especially in the elderly when there is an unfavourable risk-benefit ratio.
Yes it is possible that some hernias will not need any treatment. However, you should consult a surgeon to know whether it is advisable to wait or get operated.
There are different techniques of hernia repair. There is no single procedure that would work in all cases. There are various open and laparoscopic procedures which generally have the basic principle to close the defect without tension and then reinforce with an appropriate mesh.
Traditional surgeries give high recurrence rates for large and complex hernias.
Recent times have seen a rapid proliferation of newer procedures with the purpose of reducing recurrence such as Component Separation Techniques and Peritoneal Flap method. Many of these can be done with keyhole methods too in expert hands.
Choose a center where there is high volume with surgeons trained in repairs for complex hernia
We have devised a clinical pathway based on which we optimise and apply different strategy for different patients. This depends on the type of obesity, body mass index (BMI), diabetes, and also on the complexity of hernias. Sometimes, we need to perform bariatric surgery (laparoscopic weight loss surgery) before taking the patient for hernia surgery.
Before undergoing the surgery, do have a discussion with your surgeon about the mesh. There are many in the market and choosing the right mesh for the right patient may be an important deciding factor for the outcome of the surgery