Do you have a lump protruding from the belly button or groin or other parts of the abdominal wall that sometimes goes away on lying flat, and shows up when you cough or urinate or defecate? Is the lump painful at times and is difficult to push back in? Have you ever been told you have a hernia?
A hernia arises when there is an abnormal opening or defect in the investing layer of the abdominal wall, therefore the contents inside the abdomen protrudes the skin giving rise to a lump that often goes away and return depending on position or activity.
A hernia can be congenital as seen in most newborn and toddlers however it can close on its own by age 4. If it persists beyond that age, then it is unlikely to close by itself and surgical intervention is needed. A hernia can be caused by anything that increases the pressure within the abdomen such as pregnancy, prolonged constipation, prolonged urinary retention etc. A hernia may also arise from a previous abdominal wound whether surgical or nonsurgical.
Diagnosing a hernia will require a detailed and complete history, physical examination and investigation. Investigation will require blood test, urine culture, chest X-rays, abdominal ultrasound and colonoscopy, especially in the adult population.
A hernia is usually treated with surgery. The main types of hernia surgery are open repair and closed (laparoscopic - minimally invasive) repair.
Open hernia repair is where an incision, or cut, is made in the groin. The hernia “sac” containing the bulging intestine is identified. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with stitches or synthetic mesh. Most patients will be able to go home a few hours after surgery, and feel fine within a few days. Strenuous activity and exercise are restricted for four to six weeks after the surgery.
Closed (Laparoscopic or minimally invasive) hernia repair uses a laparoscope, a thin, telescope-like instrument that is inserted through a small incision at the umbilicus (belly button). The laparoscope is connected to a tiny video camera, smaller than a dime, that projects an "inside view" of your body onto television screens in the operating room.
The abdomen is inflated with a harmless gas (carbon dioxide), which creates space to allow the surgeon to view your internal structures. The inner lining of the abdomen is cut to expose the weakness in the abdominal wall. A mesh is placed on the inside to cover the defects in the abdominal wall and strengthen the tissue.
After the procedure is completed, the small abdominal incisions are closed with a stitch or two, or with surgical tape. Within a few months, the incisions are barely visible.
It is important to treat hernia because they have the potential to complicate when parts of internal organs (such as a knuckle of small intestine or bowel) get trapped within the hernia sac, this is called incarcerated hernia. An incarcerated hernia can further complicate by constriction of its blood supply, this is called a strangulated hernia and both conditions are potentially life threatening. To treat these conditions will require a more extensive surgical wound and possible removal of a part of the trapped internal organ such as the bowel. It is difficult to predict when a hernia will complicate so it is recommended to treat it electively as soon as it is diagnosed to avoid the unwanted complications of delayed treatment.
The risk associated with surgery is low and includes:
- Anesthetic complications such as reaction to medications used
- Urinary retention, especially following spinal anesthesia.
- There can be bleeding during and after surgery.
- Damage to nearby structures during surgery, such as nerves, blood vessels and bladder.
- Infection occurring immediately or shortly after surgery.
For patients who underwent a laparoscopic procedure you may experience some back and chest pain, as well as abdominal pain, shoulder pain, and bloating due to the carbon dioxide gas used during the operation becoming trapped in the abdominal cavity. These symptoms will likely subside on their own. However, if patients can’t endure them, they should consult with their physician regarding appropriate medication to help relieve the symptoms. To reduce your chances of developing a surgical complication it is important to follow the instructions of your doctor before and after surgery.