Written by Dr Aparna Govil Bhasker
Hernia is the protrusion of an organ or tissue from an abnormal opening in the muscle or tissue that holds it in place. A hernia can be seen in all age-groups and genders. In children, congenital hernias are common, inguinal hernias are seen more often in men, while umbilical and femoral hernias are seen more commonly in women.
The most common types of hernias are-
*Inguinal (in the groin)- 73%
*Femoral (below the groin in upper thigh)- 17%
*Umbilical (through the navel)- 8.5%
*Congenital (abdominal organ, bowel or viscera)
*Epigastric (above the navel, in the midline)
*Incisional (through the scars of any previous surgery)
*Rare types- lumbar, spigelian, obturator and gluteal
The two main factors that are implicated in causing a hernia are the weakness of abdominal muscles and increased pressure inside the abdomen which tends to force the internal contents out through the weakened area. Abdominal wall weakness may be congenital or could be a result of excessive fat, repeated pregnancies, or a surgical incision. On the other hand, increased abdominal pressure may be a result of long-standing cough, constipation, urinary straining, heavy exercise, and so on.
When to get a medical check-up done?
Most patients consult experts with complaints of a dragging and aching pain and/or a lump that may increase in size on exertion and reduce in size on resting or lying down. Sometimes, the hernia may get obstructed or strangulated and, in that case, may present
with vomiting, constipation, and a swollen abdomen along with severe pain in the abdomen. If you are experiencing any kind of pain or a lump in the abdominal or groin area, it is advisable to visit a surgeon for a check-up. The diagnosis of hernia is usually by clinical examination. Investigations like ultrasonography or CT scan may be required. At the same time, it is also important to determine the cause of hernia.
The treatment is mainly surgical; hernia cannot be treated by medicines alone. Hernia surgery usually involves the reduction of hernial contents, repair of the defect, and reinforcement of the defect with a mesh. Surgery can be performed either through open technique or by laparoscopy. The choice of technique (open/laparoscopic) depends upon the clinical characteristics of the hernia and the preference of the operating surgeon. While laparoscopic surgery is the preferred approach for most hernias nowadays, open hernia surgery may be required for very large, complex, or recurrent hernias. Laparoscopy has many advantages over open surgery as it causes very little trauma, less pain, early recovery, early discharge from the hospital, and earlier return to work. Nowadays even complex hernia surgeries are being performed successfully through the laparoscopic technique.
Hernia surgery is one of the most common surgeries that is performed across the world. If you feel that you do have a bulge anywhere on your abdomen or in the region of the groin, do consult a surgeon immediately.
After the surgery, it is important to take care and not overexert yourself for the first few months. Recurrence of hernia is a well-known complication and can happen more in people in whom the root cause of increased pressure in the abdomen has not been treated along
with the hernia. Hence it is also important to avoid rigorous activity, treat constipation, treat the cough, and so on.
However, most patients do well after surgery. The science of hernia repair has advanced a lot and many new interventions and techniques have come in recently.
(The author is a bariatric and laparoscopic surgeon, Dr Aparna’s- Laparoscopy & Bariatric Surgery Centre, Mumbai)
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