Hernia

A bulge in the abdomen maybe a sign of hernia, which is caused by prolonged increase in intra-abdominal pressure that causes muscle weakness or loss of collagen. Some organs in the abdominal cavity may protrude through the weak point in the muscle, forming the visible bulge. Classification of hernias depends on the location and clinical presentation, such as whether it is reducible in sizes, obstruction in blood flow. Groin area, pelvis, areas around the umbilicus and diaphragm are all common sites for hernias. Inguinal hernia is the most commonly seen hernia, which is caused by weakened abdominal muscles, that leads to the intra-abdominal organs, like the small intestine or omentum, protrude into the scrotum through the groin. With current medical advances, inguinal hernia can be repaired by endoscopic surgeries.

Who are at risks of hernias?

Causes of hernias can be classified into congenital and acquired. The former one refers to congenital defects in the abdominal wall. The later one refers to chronic pressure on the abdominal wall that causes the loss of collagen and weakening of the muscle, so the intra-abdominal organs may protrude through the weak point. People who engaged in manual labor or weight lifting, constipation, or have problems with prostate glands may have higher risk of developing hernias.

How does hernia affect my health?

Do not underestimate the severity of hernias. Besides obstructing blood flow, involved area may become ischemic, causing tissue death, or even peritonitis in severe cases. The protruding parts may cause pain or redness, and the pain may spread through the abdomen.

How to diagnose hernias?

In general, doctors can diagnose if a patient has hernias with physical examination. Symptoms of hernia include a visible lump in the abdomen, which increases in size when the patient is coughing, standing or exercising, and it is reducible when the patient lays down.

How to treat hernias?

Hernia is a structural problem that is incurable by medication. Surgery is the only cure. Surgeries include conventional open surgery and minimally invasive laparoscopic repair that places a synthetic mesh at the weak point to prevent the intestine or other organs protrusion through the weak point, which leads to obstruction and ischemia.

Both surgeries are performed under general anesthesia, but laparoscopic surgery is preferred over conventional one in case of bilateral inguinal hernia. Laparoscopic surgery requires only three small incisions on the abdomen (5mm x 2 + 1cm x 1). Conventional surgery requires two incisions on both sides of the abdomen, 3-4 cm in length for each. The wound would be larger in conventional surgery and scarring is inevitable, though most surgeons would make the incision at bikini lines, so patients can hide the scars easily. Apart from that, the synthetic mesh has to be placed between two muscle layers, so incision has to be made on the muscles in order to place the mesh.

Minimally invasive surgery can place the mesh between the bottom of the muscle and the peritoneum, via a 1cm incision. Therefore less discomfort will be experienced by patients during recovery. After conventional surgery, the incised muscles will slowly grow back together in one piece, which may cause mild to moderate pain during recovery. For both types of surgeries, the length of stay is about 1-2 nights. Normally recurrence after placing synthetic mesh is less than 3%.

Prevention:

Hernia is a structural problem which is relatively difficult to prevent in nature. However, by preventing exercises that stress the abdominal muscles such as sit-up and weight lifting, as well as having enough rest can avoid unnecessary pressure on the abdominal wall.