Hernia is a common problem that causes a bulge in the abdomen or groin. It can often be harmless and pain-free, but at times it can bring discomfort and pain. Abdominal complaints may signal a serious problem.
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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.
Hernias can commonly be found in the following areas:
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:
The risk factors can be broken down by hernia type:
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 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:
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.
Treatment depends on the nature of the hernia. Three varieties of hernias are most commonly identified:
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.
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:
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:
Source: Medical News Today