dr ajay prakash

It is the protrusion (bulge) of abdominal viscera through a weakened part of abdominal wall.

The common type of hernias in the groin (inguinal),belly button (umbilical)and the site of a previous operation (incisional). There are many more types but are rare.

Inguinal hernias: Are groin swellings found most commonly in males and may be found at any age. They are due to defects in the musculature of the abdominal wall which allow protrusion of intra abdominal contents, usually the intestines.

Femoral hernias : Occur slightly lower down in the groin usually in females.

Paraumbilical hernias: Are adjacent to the navel and are acquired in adulthood.

Umbilical hernias : Are swellings coming through the navel and are present from birth.

Incisional hernias : Are defects arising in a previous abdominal wound.

Hiatus hernia : Is very common and is due to the stomach sliding up.

If you have an inguinal hernia, the most common finding is in the swelling of the groin. The scrotum may also be enlarged. This lump will often be clearly visible beneath the skin. It may disappear when you lie down, and appear again if you cough, sneeze or strain on the toilet. Some hernias cause no pain at all, while others cause a dull aching sensation which is more pronounced during physical activity.

A strangulated hernia, which is a dangerous complication of the condition, is a medical emergency where a loop of bowel becomes trapped in the hernia defect. It generally causes intense abdominal pain and can be lethal. If dealth with quickly, complete recovery should follow.

A hernia can develop very gradually, over a period of years, or it may come on suddenly. Sometimes a hernia is present at birth (see hernias iom children).

The only way of curing a hernia is by surgical repair. There are no drug treatments for the condition. The prospect of having an operation may seem daunting, especially if you have a reducible hernia which is not really causing much discomfort. However, remember that hernias do tend to get worse over time, and there is always a risk - however small - of developing the serious complication of a strangulated hernia. Hernia surgery is better carried out sooner, rather than later. However, it is important you discuss the different surgical options in detail with your doctor before coming to any decisions.

The traditional operation for hernia involves stitching and a general anaesthetic. The surgeon makes an incision in the abdominal wall around the hernia and first moves the hernia back into position within the abdominal cavity. The weak portion of the abdominal wall is then stitched back together.
More recent variations on this technique use patching the defect after it has been stitched up or maybe putting in a staple - the aim being to stop the weak section from opening up again. You may be admitted as a day case, or you may need to stay in hospital overnight, or even for a few days.
However it is done, this operation creates tension within the deep layers of the abdominal wall, which causes pain after the operation. The length of time the pain persists for and its intensity depends on the type of operation and how complex the hernia was to repair. You can generally expect degree of restriction in physical activity for some weeks after this kind of operation.

Now the most common form of hernia repair, this procedure is normally done under local anaesthetic. An incision is made over the site of the hernia and, as in the traditional method, the bulge is pushed back into place. The actual repair is done by placing a piece of fine, sterile mesh at the weak point of the abdominal wall. This is held firmly in place and the outer incision on the skin surface closed. The process only takes a few minutes.
Some surgeons still use some stitching in mesh repair, but it is possible to do the operation without stitching of the deeper layers of the abdominal wall. In this case no tension can develop within the muscle tissue. This means there is far less pain and discomfort than with traditional surgery. Since only a local anaesthetic is used, recovery time is much faster. Many patients can go home within an hour or so of the operation and an overnight stay is rarely needed. The mesh triggers a natural healing process.

Laparoscopic surgery:
Sometimes known as keyhole surgery, the laparoscopic technique involves a repair of the hernia from inside the abdomen. Using either general or spinal anaesthesia, the surgeon makes a tiny incision near the hernia. Through this, miniature surgical instruments - including a video camera - are introduced and used to make the repair. The camera projects an image of the operation site onto a screen, which guides the surgeon's actions.
Because the incision is very small, there is less post-operative pain and faster healing than with the two 'open' techniques described above. However, in the hands of an inexperienced operator, laparoscopic techniques can cause damage to surrounding tissue because the surgeon has less control than with 'open' surgery. Laparoscopic repair for hernia has only really come into its own in the last few years but recent guidance from NICE (the National Institute for Clinical Excellence) says that it should be considered as an option alongside open surgery, depending on the exact nature of the hernia, the surgeon's experience in laparosopic surgery and the patient's ability to take general anaesthetic.
A surgical truss might be suggested if there has to be a wait for surgery or if, for some reason, surgery is not advisable. This is an elasticated belt which supports the abdomen and keeps the hernia from protruding. There is some evidence that wearing a truss weakens the muscles and restricts the circulation. There may have been some justification of their use in the past, when hernia repair was not so successful, but these days the patient needs to know why if his doctor recommends wearing one of these appliances.

Elective hernia repair has a high success rate, but the hernia may recur in between one to 20 per cent of cases. Recurrence is more likely with traditional surgery, but also depends upon the type of hernia and any complicating health factor. Mesh repair of a simple case of abdominal hernia is almost certain to last for life. Once a hernia has recurred it does, however, become progressively harder to repair on subsequent occasions.