This article has been reviewed and approved by Dr Aloy Mukherjee for authenticity and medical correctness on 17 Jul 2020

All about Hernia Surgery

A hernia occurs when an organ or an internal tissue bulges out through your muscles. Hernias being a structural defect, do not improve on their own, and they tend to get bigger. You will need hernia repair surgery to correct this. 

It is usually not serious. If left alone or untreated, a hernia can lead to fatal consequences.

There are different types of hernia. The nature of the surgery will depend on the type of hernia. The more complex severe the hernia, the more serious the complications can be. 

Herniorrhaphy is the oldest form of hernia surgery. With the evolution of modern and newer techniques, hernioplasty is the treatment of choice for most simple hernias. A prosthetic mesh is used in almost all repairs to bridge the defect. There are laparoscopic or robotic methods for this surgery. A surgical hernia repair pushes the hernia back into the body part from where it was bulging out.

Types of hernia

There are six main types of hernia. These are

  1. Epigastric hernia: These occur in the abdomen between your belly button and the rib cage. You will feel it more when you cough, laugh or sit down for bowel movement.
  2. Umbilical hernia: In this, the hernia pushes out through a weakness in your belly button area. It will pain more when you cough or when you strain during a bowel movement.
  3. Hiatal hernia: It occurs when the stomach bulges through the diaphragm. The diaphragm is a thin skeletal muscle in the base of the chest, which separates the lungs from the abdomen. You may be born with a hiatal hernia, or you may develop it as you age.
  4. Inguinal hernia: In this type, your small intestine pushes out through the inguinal canal in your groin area. It usually occurs on the right side and is more common in men than women.
  5. Femoral hernia:  This type of hernia happens when the tissue bulges from a weak point in your inner thigh area or groin. Women tend to have this more than men
  6. Incisional hernia: It is usually a side effect of stomach surgery when the surgical wound is not closed or healed properly.

What are the causes of hernia?

Hernias develop due to strain and muscle weakness. It can progress rapidly or over a while. Some of the main reasons for muscle weakness and strain are 

  • A genetic condition that is present from birth 
  • Muscle laxity with aging  
  • Being overweight or obese
  • Fluid in the abdomen (ascites)
  • Pregnancy 
  • Strenuous activities such as lifting heavyweights 
  • Damage from any injuries or surgeries
  • Constipation - It causes you to strain when you have a bowel movement 
  • Straining during urination
  • Prolonged bouts of coughing or sneezing

What are the risk factors of hernia?

The main risk factors are

  • Gender - Men are much more likely to have inguinal hernia than women
  • Age - The risk of hernia increases with age
  • Cystic fibrosis
  • Premature birth or born with a low birth weight 
  • Smoking - This leads to a weakening of the connective tissue
  • Family history of hernias
  • Personal history of hernia
  • Pregnancy 
  • Chronic cough and chronic constipation 

Diagnosis of hernia

Your doctor will be able to diagnose an inguinal hernia through a simple physical exam. In cases where it is not apparent, the doctor will use some imaging tests. These tests include

  • Abdominal ultrasound - This test uses high-frequency sound waves to create an image of your internal structures in your body. 
  • MRI scan - It uses a combination of strong magnets and radio waves to produce an image. 
  • Endoscopy - This involves inserting a small camera that is attached to a tube down your throat. It will extend into your stomach and esophagus. It will help your doctors see the location of the hernia.
  • Gastrografin swallow test- It shows an outline of the stomach and esophagus on an X-ray.

 

The doctor will determine the nature of the hernia as that affects the type of surgery. Your hernia can be of three different kinds. These are

  1. Reducible hernia - This is when the hernia can be pushed back into the opening it came through. 
  2. Irreducible or incarcerated hernia - This occurs when the organ or abdominal tissues have filled the hernia sac. It cannot be pushed back into the opening from which it came out. This condition needs early intervention.
  3. Strangulated hernia: It is an emergency condition that needs immediate surgery. You may have pain and irreducibility as a sign before this. It occurs when the tissue or a part of an organ gets stuck inside the hernia. Due to this, the blood supply to that part gets cut off, and that part becomes gangrenous within hours. 

All hernias need to be repaired in time because if left unattended, they can lead to incarceration and strangulation. 

Treatment for hernia 

You will need a hernia repair surgery to correct your hernia. There are two main types of hernia repair. 

  1. Herniorrhaphy or tissue repair - In this, the surgeon will make an incision over the hernia. Through this hole, the surgeon will push back the tissues or organs that have come out, to its proper location. The surgeon will then remove the hernia sac, stitches the sides of the hole, and close it.
  2. Hernioplasty or mesh repair - The surgeon, instead of closing the hole, covers it with a prosthetic polypropylene mesh. The nearby damaged tissues use this mesh as a support while they regrow. 

Component separation- This is for exceptionally large and complex hernias. Usually, a Posterior component separation(PCS) by the Transversus Abdominis Release(TAR) is the preferred option over the Anterior Component separation(ACS).

Types of hernia surgery

There are two main types of hernia repair surgery. These are

1. Open hernia surgery  

In this procedure, your surgeon will make an incision over the hernia. Then, the hernia is either gently pushed back into place, removed, or tied off. The area where the hernia is pushed back in is closed with stitches.

In the case of larger hernias, your surgeon will add a flexible mesh for extra support. It will prevent the hernia from coming back. 

You will be under general anesthesia or regional/local anesthesia during the surgery. Most patients will be able to go home fully recovered within a few days after the surgery. You will have to avoid strenuous activity and exercise for a couple of weeks after the surgery. 

2.Laparoscopic hernia repair surgery 

It is a minimally invasive surgery. The surgeons will make many small incisions near the hernia. They will then insert a thin tube, with a camera, into your abdomen. The surgeon will use images from this camera as guidance to repair the hernia with a mesh. You will feel no pain during the surgery, as you will be under general anesthesia. After the surgery, the incision will be closed with stitches. 

Recovery from hernia surgery

It will take 1-2 weeks after the surgery for you to get back to your normal routine. You should be careful not to lift any weights heavier than 5 kilograms(10 pounds). A full recovery may take 4-6 weeks.

Complications of hernia surgery

Possible complications and risks from hernia surgery include

  • Infection
  • Organ or tissue damage
  • Return of the hernia
  • Pain due to the mesh
  • Blood clots
  • Urinary tract infection 
  • Incontinence or urine leaking 
  • Nerve damage
  • An incisional hernia that develops through a surgical cut 
  • Bleeding 

Prevention of hernia

You may not be able to prevent hernia in most cases. However, there are some steps that will reduce the risk of having a hernia. These are

  • Maintain a healthy weight- Being overweight or obese increases the chances of hernia
  • Stop smoking - Smoking weakens your abdomen wall making you more prone to hernia
  • Eat healthy foods - Foods that have a high fiber and water content will help relieve constipation. It thus avoids strain during bowel movements.
  • Physical activity- Regular exercises to strengthen your abdomen can prevent hernia
  • Avoid lifting weights - If you must lift, make sure you bend at the knees and not at the waist.

Hernia surgery in India
Hernia surgery in India

References / Additional Reading
This article has been reviewed by Dr Aloy Mukherjee for authenticity and medical correctness on 17 Jul 2020
Dr Aloy Mukherjee
Dr Aloy Mukherjee
MBBS, MS (Surgery), MAMS, FALS, FMAS, Fellow IAGES, Robotic(da Vinci )
Dr. Aloy J Mukherjee is an Advanced Minimal Access, Gastro-Intestinal , HPB , Obesity and Metabolic Surgical Specialist (Bariatric), Thoracoscopic and Endocrine( Thyroid, Parathyroid, Breast, Adrenal Gland) Surgeon. He specialises in Laparoscopy or Robotic Surgery. Dr Mukherjee has an experience of 23+ years in these fields. After completing his MBBS from Gauhati Medical College, Guwahati in 1993 and Masters in Surgery (General Surgery) in 2001,he completed his senior residency from AIIMS, New Delhi in 2004. He was awarded Fellowship of the Indian Association of Gastro Intestinal Endo Surgeons in 2008.In 2008, he was conferred the Honorary membership of the National Academy of Medical Sciences (India) in recognition to the significant contribution for advancement of Medical Sciences. He received his Robotic Surgical training in 2016 and received his Fellowship in Advanced Laparoscopic Surgery(FALS) and Fellowship in Minimal Access Surgery(FMAS) in 2017.
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