On average 120,000 hernia operations are performed in the UK each year, Mr Simon Wemyss-Holden, Consultant General & Laparoscopic Surgeon discusses this common complaint.
Hernias can occur for various reasons, typically during sports activities or when performing manual tasks such as lifting and stretching - following which you may experience a sharp pain or notice the appearance of a swelling. It might take a long time for a hernia to develop or it could develop suddenly.
A hernia is a small lump that occurs when some of the contents of the abdomen (such as part of the intestine) push through a weakness in the abdominal wall. Picture your most comfortable armchair, you know, the one with all the stuffing protruding out the sides, well it's the same concept.
Hernias can occur in anyone, although more commonly in men than women. They result from a strain in the stomach or groin area when pressure is raised through activities including persistent coughing, lifting heavy objects or even straining on the toilet. They are not usually painful, but many people feel an ache over a hernia which worsens after any activity. In time, the hernia might become bigger as the gap in the muscle or ligament tissue becomes larger. Leaving your hernia untreated may cause it to become larger and uncomfortable and therefore a hernia operation may be necessary not only to alleviate symptoms but more importantly to prevent complications developing.
There are four main types of hernia, the different types of hernia typically affect different groups of people.
Inguinal hernia (groin) is the most common type of hernia accounting for over three out of every four cases. Risk factors for inguinal hernia include:
- your sex, they are more common in men
- your age, they are more common as you get older
- being overweight
- performing lots of heavy lifting
- having a chronic, long term cough
- having chronic constipation
Femoral hernia (lower groin) is less common with an average of 3,400 femoral hernia repairs performed in the UK each year. Femoral hernias are four times more common in women than men and there is a high risk of serious problems if femoral hernias are left untreated.
Incisional hernia occurs when body tissue pushes through a previous scar or wound. They are more common if you've had a scar in the past which didn't heal correctly (for example, the wound had an infection following surgery). Incisional hernias typically occur within two years of the original operation.
Umbilical hernia (belly button) occur around the belly button and can be present from birth. They are more common in children and nine out of ten cases get better without treatment. Surgical intervention would be required if the hernia does not resolve unaided. Adults who develop an umbilical hernia will require surgery as it will not get better without intervention.
What is a hernia operation?
The type of surgery you receive will depend on the type of hernia you have. There are two types of surgical technique to correct a hernia.
Laparoscopic (keyhole) surgery involves three small cuts (0.5 to 1cm long) on your abdomen whilst under a general anaesthetic (with you asleep). The surgeon then inserts a telescopic camera just below the tummy button to view the hernia on a video monitor. The hernia is then repaired using specially designed surgical instruments passed through the 2 other cuts. A strong synthetic mesh is attached to the inside of the abdominal wall to reinforce the 'hole' thereby repairing the hernia.
Open surgery requires a single cut (5 - 10cm long) to the skin over the hernia. Under local or general anaesthetic the 'bulge' is pushed back into place and your surgeon stitches a synthetic mesh over the weak spot, similar to laparoscopic surgery. The cut skin is then closed with dissolvable stitches. Both laparoscopic and open surgery take on average 20 to 40 minutes in theatre and are performed as a day case procedure meaning you could go home on the same day.
Although I perform both open and laparoscopic hernia repair, I usually advise the laparoscopic operation in the majority of cases as the recovery time is reduced with most patients returning to work after about 10 days rather a 6 - 8 weeks after an open operation. The advantage of an open repair however is that it can be performed under local anaesthetic which avoids the need for general anaesthetic.
What are the risks?
Hernia repair is a commonly performed and generally safe operation. Your surgeon will discuss the risks and possible complications during a one-to-one consultation prior to any surgery being performed. Some of the complications associated with a hernia repair may include:
- a build-up of blood or fluid in the space left by the hernia, this will usually get better without treatment
- pain or numbness caused by damage to the nerve, stitches trapping a nerve, mesh applied too tightly or scar tissue forming (this is more likely during open surgery)
- the wound becoming infected requiring antibiotic treatment
- there is about a 1/200 chance of the hernia reoccurring
There have been major advances in hernia surgery over the course of the last 10 to 15 years including the introduction of new meshes and the development of the laparoscopic repair. The operation can now be tailored to patients' individual requirements and recover times after surgery are generally much reduced. Your surgeon will discuss all of this with you during your consultation in order for you to make an informed decision about surgery.
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