Laser treatment of hernia

Hernia - symptoms

Hernia is usually straightforward to diagnose, as it forms a bulge in the abdomen or in the groin due to weakness or hole in the peritoneum that keeps abdominal organs in place. This defect in the peritoneum allows organs and tissues to push through, producing a bulge. The lump may disappear when the person lies down, and reappear when the muscles are strained, for example during coughing, exertion or lifting heavy objects. In some cases, the condition may require immediate surgical intervention when part of the bowel becomes obstructed by an inguinal hernia.

Types of hernia

Hernias can commonly be found in the following areas:

• Perineum: a femoral hernia creates a bulge just below the groin. It is more common in women.
• Groin: an inguinal hernia is more common in men. It is a bulge in the groin that may reach the scrotum.
• Upper part of the stomach: a hiatal or hiatus hernia is caused by the upper part of the stomach pushing out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.
• Belly button: a bulge in this region is produced by an umbilical or periumbilical hernia.
• Surgical scar: past abdominal surgery can lead to an incisional hernia through the scar.

Causes of hernia

With the exception of an incisional hernia (a complication of abdominal surgery), in most cases, there is no obvious reason for a hernia to occur. Hernia can be congenital (present at birth) or develop in children who have a weakness in their abdominal wall. In addition, its risk increases with age and is more common in men than in women.

Activities and medical problems that increase pressure on the abdominal wall can lead to a hernia. These include:

• straining on the toilet (due to long-term constipation, for example),
• persistent cough,
• cystic fibrosis,
• enlarged prostate,
• being overweight or obese,
• abdominal fluid,
• lifting heavy items,
• peritoneal dialysis,
• poor nutrition,
• smoking,
• physical exertion,
• undescended testicles.

Risk factors for hernia

The risk factors can be broken down by hernia type:

• Incisional hernia risk factors: Because an incisional hernia is the result of surgery, the clearest risk factor is a recent surgical procedure on the abdomen. People are most susceptible to developing hernia 3-6 months after surgery, especially if this is accompanied by strenuous activity, weight gain or pregnancy.
• Inguinal hernia risk factors: Those with a higher risk of inguinal hernia incude: older adults, people with close relatives who have had inguinal hernias, males, people with chronic constipation, premature and low birth weight infants, pregnant women and smokers, as chemicals in tobacco weaken tissues, increasing the risk of hernia.
• Umbilical hernia risk factors: Umbilical hernias are most common in babies with a low birth weight, as well as premature babies. In adults, the risk factors include: being overweight, having multiple pregnancies.
• Hiatal hernia risk factors: The risk of hiatal hernia is higher in people aged 50+ or suffering from obesity.

Treatment of hernia

For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias, which result in intestinal obstruction in 40 % of patients within 2 years of diagnosis.

Immediate medical attention should be sought if an inguinal hernia causes acute abdominal complaints such as pain, nausea, vomiting or bulging of significant size. Although the American College of Surgeons and some other medical institutions consider surgery unnecessary, recommending careful observation and waiting, surgery may be worth considering to eliminate the risk of intestinal obstruction in the future.

Hernia repair surgery

Hernia repair surgery is considered quite safe and effective and is one of the most commonly performed procedures. According to a 2014 study by the Association of VA Surgeons, more than 350,000 ventral or abdominal hernia procedures are performed annually in the US alone. Hernia repair is an outpatient surgery and the patient may be discharged home on the same day.

Symptoms that signal the need for the surgery include:

• chronic pain or severe discomfort,
• pain or discomfort that interferes with daily activities,
• pain or discomfort which intensifies over time,
• large size of the hernia,
• rapid growth of the hernia,
• hernia types which are likely to aggravate or grow larger over time, such as in the groin,
• acute abdominal pain and vomiting,
• hernia that puts pressure on the nerves, causing irritation and numbness.

Hernia repair methods

The most commonly practised hernia repair surgery involves making an incision directly over the hernia, opening the wound enough to access it, moving the tissue or displaced organ to its original position, and removing the hernia sac. Then, the surgeon sutures the sides of the muscle opening or hole through which the hernia was protruding. After sterilisation, the wound is sutured.

In another method, instead of suturing the muscle hole, the surgeon covers it with a flat, sterile mesh, usually made of flexible plastic material, such as polypropylene or animal tissue. A small incisions in the shape of the mesh is made around the hole. Then, the patch is sewn into the healthy, intact tissues surrounding the hernia. The mesh will serve as a reinforcing scaffolding for damaged or weak tissues while they regrow.

Indications for the surgery

Treatment depends on the nature of the hernia. Three varieties of hernias are most commonly identified:

• Reducible hernia: when the hernia can be pushed back into the opening through which it protrudes.
• Irreducible or incarcerated hernia: when abdominal organs or tissues fill the hernia sac and the hernia cannot be pushed back through the opening through which it protrudes.
• Strangulated hernia: when part of an organ or tissue becomes stuck in the hernia, with the blood supply often cut off.

Both techniques of hernia repair surgery can be performed through an incision or laparoscopy, which involves accessing misplaced tissue through three or four small incisions made adjacent to the hernia. Laparoscopic surgery is performed using a fibre-optic cable with a light source, known as a laparoscope, which acts like a video camera. By inserting the laparoscope through small incisions, surgeons have a better control over the procedure.

Complications following hernia repair surgery

Full recovery from hernia repair surgery usually takes three to six weeks. The patient can usually return to his or her daily activities somewhere between 1 and 22 weeks after the procedure. However, as with all surgical procedures, hernia repair surgery carries the risk of certain complications.

The site of incision or wound will likely be noticeably swollen and red for some time. It can also be very painful and tender. Over-the-counter painkillers or anti-inflammatory drugs can help reduce the inflammation and associated symptoms. Inflammation can also be reduced by applying ice to the area for 10 minutes every hour.

Less common but possible complications and risks associated with hernia repair surgery include:

• infection,
• organ or tissue damage,
• hernia recurrence,
• formation of a fluid-filled sac under the skin surface,
• nerve damage or neuralgia that causes tingling or numbness,
• constipation or slow bowel movements,
• difficulties with passing urine,
• incontinence,
• haemorrhage or internal bleeding and haematoma or pooling of blood in the wound area,
• extensive adhesions,
• hernia as a result of surgical incision,
• fistula between two organs,
• infection of the urinary tract,
• thrombosis,
• pneumonia, lung infection or difficulty breathing,
• kidney failure.

When to consult a doctor?

After the procedure, the patient should report any instance of intensified pain or discomfort, as well as fever or skin changes around the incision area.

Complications that should be assessed by the doctor also include:

• incision that remains inflamed and painful for more than a few days after surgery, especially if the symptoms aggravate,
• new symptoms that developed a few hours after the surgery,
• hernia bulge changing colour, especially to a dark shade of red or purple,
• pallor or change in skin tone,
• odour or blood, pus or clear fluid discharged from the incision,
• hard-to-heal wounds,
• hard, swollen testicles,
• inflammation and pain that is not alleviated with painkillers or ice,
• stomach cramps,
• lack of bowel movements for 3 days or more,
• acute abdominal pain and vomiting.

Source: Medical News Today