What is a Hernia?
A hernia is a weakness or defect in the abdominal muscle wall through which part of the abdominal content protrudes (out-pouching) causing a bulge. The hernia sac (bulge) is formed by extension of the lining of the abdominal cavity (peritoneum) and may contain part of the small or large intestine. A hernia can be present at birth (congenital), but most of the time appears later in life (acquired). It is generally reducible; in this case the bulge appears intermittently and disappears easily when laying-down.
Acquired hernias may develop as a result of increased pressure within the abdominal cavity, for instance during pregnancy, heavy lifting, obesity, constipation, or chronic cough. Poor nutrition, smoking and past family history of hernia repair
are also known predisposing factors.
Abdominal wall hernia can cause symptoms including abdominal pain exacerbated with coughing or exercising, abdominal distension, burning, gurgling or dragging sensation, nausea and vomiting.
Those symptoms are often more pronounced when the hernia becomes non-reducible (incarcerated), prompting the patient to present to the hospital on emergency. On few occasions, intestine can be involved causing bowel obstruction due to strangulation. In this situation urgent hernia surgery is mandatory as any delay can lead to death of the bowel wall due to compromised blood supply, and be potentially life threatening.
Hernia can occur anywhere in the abdomen, but most commonly at weak anatomical points, mainly inguinal (groin) and umbilical (navel).
Types of Hernia
- Hiatus hernia: Occurs when a portion of the stomach is able to slide upwards through the opening in the diaphragm, beside the oesophagus, into the chest. Due to the complications of severe reflux and breathing difficulties, hiatus hernia surgery is taken up as an emergency.
- Inguinal hernia: is the most common and affects predominantly male patients due to the presence of the spermatic cord structures that cross the lower abdominal wall via the inguinal canal. Sometimes, the hernia sac can extend down to the scrotum.
- Umbilical hernia: often presents as a bulge arising through or beside (para-umbilical) the belly button. Most of the time the hernia sac content is made of intra-abdominal fat (omentum)
- Femoral hernia: is more common in female patients as they have a broader pelvis. The weak point is situated at the level of the femoral canal, just lateral to the pubic bone, where the external iliac (pelvic) vessels pass through to the lower limb. Femoral hernias tend to incarcerate and are often operated on emergency.
- Epigastric hernia: is a defect that develops at the level of the upper and middle part of the abdomen, below the xiphoid process (breastbone).
- Incisional hernia: always occurs following previous abdominal surgery and is caused by incomplete healing and residual weakness of the scar tissue. This condition is fairly commonly following a previous median vertical incision (midline laparotomy) as it may develop in more than 35% of the cases.
- Spigelian hernia (or lateral ventral hernia): is uncommon and occurs lateral to the rectus abdominis muscles, at the level of the umbilicus.
- Obturator hernia: Is a rare condition that generally develops in older female patients, particularly following recent weight loss or after a fall. It is situated in the pelvis (obturator foramen) and is often diagnosed intra-operatively following emergency surgery.
Who needs hernia surgery?
- Any patient fit for surgery and with a symptomatic hernia
- Patients with an asymptomatic hernia that is increasing in size
- Patients with an asymptomatic hernia who plan to travel abroad
- Patients with an incarcerated and/or strangulated hernia will require urgent repair
How is hernia surgery performed?
The principle of hernia repair is to dissect and reduce the content of the hernia sac back into the abdominal cavity, with closure of the overlying muscle. Generally, the repair will be reinforced with placement of a soft prosthetic mesh below (laparoscopic) the abdominal wall. This mesh is permanent and provides support for the growth of new healing tissues, thus reducing the risk of hernia recurrence.
Keyhole surgery for Hernia Repair is an excellent choice for the treatment of your hernia as this minimally invasive approach is easier on your body due to the small size of the incisions, creating significantly less pain and quicker recovery, offering an earlier return to work and to normal physical activities.
Prof. Berney is one of the leading surgeons in the field of laparoscopic (keyhole) hernia surgery. For instance, he has one of the largest single series in the world (around 1,000 cases) for laparoscopic repair of inguinal hernia, using solely fibrin glue for mesh fixation, instead of staples or tackers. As a result, in his hands the risk of developing chronic groin pain post keyhole surgery is <1%.