What is Hernia Treatment?
A hernia is a bulge or protrusion of an organ or fatty tissue through a weakened area in the muscle or connective tissue in which the organ is enclosed. A hernia can develop in any part of the body; however, the muscles of the abdominal wall are most commonly affected. Symptoms may include pain, aching, discomfort, or a heaviness in the affected area. The bulge formed is more prominent when you stand, cough or strain, and may disappear while lying down as it slips back into the abdomen.
Surgery is the treatment of choice for hernias. Surgery aims at closure and repair of the muscle wall through which the hernia protrudes and is performed as an open or minimally invasive laparoscopic procedure.
Types of Hernia
Some of the common types of hernia include:
- Inguinal Hernia: An inguinal hernia is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin (area between the upper thigh and lower abdomen) or scrotum (muscular sac containing male testes).
- Femoral Hernia: A femoral hernia develops just below the lower abdomen and upper thigh, near the groin crease or skin folds around the vagina. The bulge pushes into the femoral canal through which nerves and blood vessels run into the thigh region.
- Umbilical Hernia: Umbilical (paraumbilical) hernia is the bulge that forms near the navel or belly button when a part of the intestine, fat or fluid is pushed out through a weakened muscle of the abdomen.
- Hiatal Hernia: Hiatal hernia is a condition in which part of the stomach slides through the hiatus, an opening in the diaphragm, and protrudes into the chest.
- Incisional Hernia: A bulge around or directly along a prior abdominal surgical incision.
Indications for Hernia Treatment
Small hernias that do not cause any symptoms are usually not treated but instead your doctor may follow a wait-and-watch approach. Surgery is indicated for hernias that show symptoms, are enlarged or entrapped. A hernia can sometimes become trapped or strangulated and cannot be pushed back into the abdomen. This is referred to as an irreducible hernia. It is a dangerous situation where the blood supply to the hernia is compromised and may require emergency surgery.
Preparation for Hernia Treatment
Preoperative preparation for hernia treatment will involve the following steps:
- A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You should shower with an antibiotic soap the night or morning prior to the operation.
- You should avoid supplements or medications such as blood thinners, aspirin, NSAIDs, or vitamin E for a week or two prior to the surgery.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- Smoking cessation is advised as smoking may increase the chances of hernia recurring post surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Hernia Treatment
Treatment is decided based on the clinical condition of your hernia, general health of the patient, and if it is a recurrent hernia. The commonly adopted surgical procedures are laparoscopic or open surgery under regional or general anaesthesia.
Open surgery: In this procedure, a large incision is made in the abdomen. The protruding tissue or organ is pushed back to its original position and sewed securely. A specially designed synthetic mesh patch is then sewed over the weakened area in the abdominal wall once the hernia is pushed back to reinforce the abdominal wall, thereby reducing the risk of hernia recurrence.
Keyhole or laparoscopic surgery: In this procedure, the surgeon makes a few small incisions on your abdomen to insert the laparoscope (a small thin tube with light and a tiny video camera connected to a television monitor) and other surgical instruments. Carbon dioxide gas will be introduced to help your surgeon view the surgical site more clearly. Images captured by the laparoscope on a video monitor guide your surgeon through the surgery. Your surgeon separates the hernia sac from the surrounding tissues. The other surgical instruments inserted along with the laparoscope are used to push the organs back into their original position. A special mesh is secured by sutures, staples or tacks behind the abdominal muscles, so as to reinforce the abdominal wall and minimise the risk of hernia recurrence.
Advantages of a laparoscopic procedure over the open surgical method include shorter hospital stay, small incisions, less post-operative pain, and faster recovery. You can resume normal activities in a few days.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after hernia surgery will involve the following steps:
- You will be transferred to the recovery area to be monitored until you are awake from the anaesthesia.
- Your nurse will monitor your blood oxygen level and other vital signs as you recover.
- Retain the dressing over the incision for the first few days.
- Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Pain medicines or NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed to manage pain.
- Antibiotics are prescribed for risk of infection associated with surgery.
- Refrain from strenuous activities, lifting weights heavier than 10 pounds, and driving for the first few weeks. Gradual increase in activities over a period of time is recommended.
- Maintain a healthy diet. You are advised to get out of bed and move around as soon as possible, safely.
- You will be able to resume your normal activities, such as showering, driving, climbing stairs, and working in a week or two.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Hernia Treatment
Hernia surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:
- Blood clots
- Bruising and swelling
- Recurrence of hernia
- Chronic pain
- Mild risk of damage to blood vessels, nerves, urinary bladder, intestines, or the sperm tube