What is it?
A hernia is a weakness or defect in the abdominal wall muscle. It may be present from birth, or develop over a period of time from lifting weights and/or straining. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing discomfort and a lump or bulge felt by the patient. An inguinal hernia is a bulge you can see or feel in your groin. The bulge is a bit of fat and bowel that has slipped through a weak spot in your abdominal muscles and down into your groin. To repair a hernia, a surgeon will usually push the lump back inside your body and cover it with a patch of mesh to keep it there.
Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.
What causes a hernia?
Usually, the muscles in your abdomen are tight enough to keep your bowel and other organs in place. But some people have weak points in these muscles.
Weak spots happen in two ways.
- You're born with a weakness in the muscles in your abdomen. This can happen if the gap in the muscles (the inguinal canal) hasn't closed as it should. If this gap stays open, part of your bowel can fall through it and bulge in your groin.
- You strain too much. If you cough a lot or strain when you go to the toilet, you can damage the muscles in your abdomen. Heavy lifting can also damage the muscles. The muscles get weak or even tear, and can't keep the bowel in place.
What are the symptoms of a hernia?
If you have a hernia:
- Not everyone with a hernia has painful symptoms, your groin may feel uncomfortable and tender, especially when you bend or lift.
- You can usually see or feel a bulge or swelling in your groin. It may get bigger when you cough, bend, lift or strain.
- There's a chance that your hernia could lead to a more serious problem. It's important to see a doctor straight away if:
- Your bulge is very painful to touch
- You have bad pain in your groin that doesn't go away
- Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)
- You feel queasy or sick, or get a high temperature
- Your hernia looks red, purple or black
Course of Hernia
Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore recommend that hernias be repaired when diagnosed, unless there is serious medical problem which makes it too risky.
How do doctors diagnose a hernia?
If you have an inguinal hernia, you can probably see or feel a bulge or swelling in your groin. Doctors can usually diagnose a hernia by examining your groin. But you may also need an ultrasound or X-ray
Treatment for Hernia:
Key points about treating a hernia
- Surgery is the only treatment for a hernia.
- Open surgery is done through a cut that opens up your groin. Or you can have keyhole surgery, where the surgeon uses a camera to see inside your groin.
- If you don't have surgery, the bit of bowel that has slipped out of your abdomen can get trapped and lose its blood supply. This can be life-threatening.
How can operation help?
Having keyhole surgery to repair your hernia will:
- Get rid of the bulge in your groin.
- Make your groin more comfortable and less painful. This will mean you can get back to normal activities and work.
- Stop your bowel getting trapped in the hernia and losing its blood supply. This is called a strangulated hernia. It can be life-threatening.
There are two main ways to do this operation
- Open surgery, where the surgeon cuts open your groin.
This is the standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures and a prosthetic material/mesh to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair.
- Laparoscopic (Keyhole) surgery, where the surgeon makes a few tiny cuts in your abdomen and uses a camera to see inside your groin instead of opening it up.
Here's what happens during laparoscopic surgery.
The surgeon makes a small cut in, or just below, your belly button.
A thin tube with a light and camera on the end (called a laparoscope) is put through the cut and down to your groin. The camera sends pictures to a television screen so the surgeon can see inside your groin.
Instruments to repair the hernia are put in through one or more small cuts lower down your abdomen.
Your surgeon pushes the bit of bowel in the hernia back into the abdomen and closes the hole, usually with a mesh patch.
There are several ways of doing keyhole surgery. Some surgeons cut through the thin film of tissue (peritoneum) that covers the bowel and organs in your abdomen to reach the hernia. They then fill your abdomen with air to make it easy to see in and around the hernia. Doctors call this transabdominal preperitoneal laparoscopic repair (TAPP).
Another way of doing the operation is to mend the hernia without going through the peritoneum. This is called totally extraperitoneal laparoscopic repair (TEP). Keyhole operations aren't usually done on babies or children.
What are the risks of surgery?
The risks of hernia surgery are very low. All surgery has an element of risk, however, and this includes the risks from anaesthesia. Your anaesthetist will be able to advise you on this. The risks of surgery itself includes infection and haematoma (bruising) occur in around 1 out of every 50 operations. A similar number of patients experience some long-term pain over the site of the operation. This may require pain-killers, injections and, in rare circumstances, a further operation. After any type of hernia surgery, there is a chance that the hernia may come back. The chance of this is around 1 in 50 for small groin hernias, but may be as high as 1 in 10 for large incisional hernias. These recurrences should be helped by and suitable for further surgery.
Which type of operation works best?
Hernia operation with open techniques is still a valid option reaching the highest standards of care. Laparoscopic techniques of hernia repair are especially attractive when patients are dealing with recurrent hernias or bilateral inguinal hernias. The risk that your hernia will come back is about the same for keyhole and open surgery. Between 3 and 9 out of 100 hernias come back. If your hernia comes back, it's most likely to happen in the first five years after surgery.
The National Institute for Health and Clinical Excellence (NICE), the government organisation that advises doctors about treatments, says Keyhole and open surgery for a hernia are both safe and work well.