Why do people get hernias?
Hernias are a very common clinical finding among the population. A hernia can appear at any age and usually happens due to some weaknesses in the muscular walls that create the abdominal cavity. There are some theories about the physical composition of the abdominal wall layers which can be damaged. A history of trauma can also be obtained from different patients or a stab wound or a history of infection. There is no racial predisposition and obviously maintaining a good physical condition might make it less frequent. A history of heavy physical straining such as lifting can also be obtained from many patients. Recently some theories about a connection between heredity and hernia formation have come out. These theories are not proven yet but the focus is on connective tissue composition which is prone to development of hernia.
When is it necessary to have my hernia repaired?
Once the clinical diagnosis of a hernia is made the advice given to any potential patient is to repair the defect. The reason is to prevent future complications such as incarceration or strangulation also it is easier to repair a hernia when it is smaller rather than when it is getting larger over time. Increased amount of pain is a very good indication that the hernia should be attended to sooner rather than later. When the hernia becomes incarcerated (bulges out) without any ability to reduce, it calls for immediate attention. Longstanding incarceration can lead to strangulation where blood supply to the bowel or any other structure is impaired.
Why do people get recurrent hernias?
As in any other surgical procedure there is a risk of recurrence. Specifically when we talk about hernias the quoted recurrence rate is about 1½%. The exact reason for the recurrence is not always know but it can be due to tissue qualities, infection or bad technique. Recurrent hernias can be redone either through the same old incision or endoscopically.
How is a hernia diagnosed?
In most cases a hernia can be diagnosed on the basis of clinical findings. When the patient complains about specific pain in any of the hernia areas it is usually accompanied with a bulge or swelling that can indicate the presence of a hernia. On rare occasions when the diagnosis is difficult to make then a CT Scan can be helpful.
How much pain should I expect after a hernia repair:
Pain after a hernia operation is a common occurrence. When a inguinal hernia is repaired a patient should expect to have two to three days of discomfort and pain. Obviously it is a subjective issue and every patient will experience a different level of pain. On rare occasions a nerve can be entrapped in the repair which can cause prolonged pain. This can be solved through different methods and one can discuss this possibility with the surgeon. Basically oral pain medications is all that the patient would need for the immediate pain control.
Since pain is a subjective measure there are some patients who will complain about pain, discomfort for a longer time. Because of the subjective nature of these complaints it might be difficult to give a satisfactory answer to those patients who have prolonged periods of discomfort. In the majority of these cases this amount of discomfort of funny feelings around the hernia repair site will disappear with time.
Are women getting Hernias as frequently as males?
Statistically speaking women get less hernias than their male counterparts but it is still affecting them. The basic clinical presentation is the same as for males and the advice to repair them once the diagnosis is made is as valid as for the males.
Are there new types of mesh available?
Over the last decade the plastic mesh that I use now for the repair were refined. Now the mesh is thinner and much more pliable and the pores are bigger allowing tissue to grow into the mesh and incorporate the mesh in the healing as well as strengthening process.
Why is mesh, a foreign body, used for hernia repair?
Instead of bunching the tissues together to close a defect a special medical mesh (net) is used to gap the defect. Here the mesh is sutured to the edge of the defect allowing the procedure to be done without tension on the tissues which results in less pain. Also the mesh allows growth of normal tissue into the fabric of the mesh. The mesh itself is made out of special synthetic fibers that are inert.
What is the difference between strangulation and incarceration?
These two definitions describe a situation in which the hernia content is bulging out through the hernia defect. It can stay out without any danger beside being painful and that describes an incarcerated hernia. In the case of strangulation there is a compromise to the blood supply which makes it an urgent situation requiring urgent treatment.
Should I use a hernia belt (hernia support) as treatment?
The basic answer is that this hernia belt only gives a temporary and subjective relief for the hernia. It should not be defined as a treatment because it does not take away the hernia and on the contrary can cause even more adhesions between the hernia content and the abdominal wall. Those adhesions can be a problem if the hernia belt was used for a long time making those adhesions very tight and hard. An extremely long usage of the hernia belt can lead to numerous complications and it is advisable not to use it on a long term basis.
What other types of problems can mimic an inguinal hernia?
At times inflammation of the lymph nodes in the groin can cause swelling and pain typical of an inguinal hernia. There are some physical findings that upon examination can differentiate between the two and might use some other imaging modalities to differentiate between the two. An ultrasound of the groin can be very helpful to make the right diagnosis and if it's not enough then a CT scan can help as well. Other clinical situations that can mimic inguinal hernia page are hip pain, arthritic changes or muscle strain. All of the above should be ruled out before the diagnosis of hernia is made.
In rare situations a torsion of a testicle can cause severe pain and discomfort in the groin area. This represents an emergency situation in which immediate help is necessary. This particular situation can be clinically diagnosed and also an ultrasound can be helpful to make this diagnosis.
What happens if I leave my hernia untreated for too long?
The natural progression of a hernia involves an increase in size, pushing intra abdominal content such as your bowel into the hernia sac. Progressive changes in the local anatomy and weakening of the surrounding tissues due to the pressure can also occur. This long term condition can make repair much more difficult because of aforementioned reasons. At times a long standing hernia can cause damage to the overlying skin.
Age and hernia repair:
A hernia can occur at a very early age or childhood. Infant hernias and children’s hernia are very common and these types of hernias are typically dealt with by pediatric surgeons. On the other hand patients over the age of 14 are often considered as adults. The clinical judgment to operate will depend on the clinical presentation. Usually for children of a young age no mesh is applied and it can be done endoscopically.
Open hernia repair vs. endoscopic hernia repair?
Basically both are very good methods. The open hernia repair approach is a very simple reliable and time tested operation. It provides an excellent repair with very few possible complications. With the endoscopic repair there is a need for general anesthesia and if complications occur they can be more difficult to repair. Also in the male population that might need future endoscopic prostate operations the endoscopic repair will cause some difficulties with regard to the prostate operation.