What people usually call hernia is called extra-abdominal hernia, which is a protrusion of intra-abdominal organs or tissues out of the body through a weak point or defect in the abdominal wall; depending on the occurrence site, common hernias are divided into inguinal hernia, femoral hernia, umbilical hernia, white line hernia and incisional hernia. Hernia occurs in 3 million people in China every year, and more than 90% of them are inguinal hernias.
In addition to weakness or defect of the abdominal wall, hernias are often associated with the following factors that lead to increased intra-abdominal pressure, such as coughing, constipation, difficulty urinating and ascites. Figuratively speaking, a hernia is a “hole” in the abdominal wall tissue from which an organ or tissue, such as the small intestine, protrudes when the intra-abdominal pressure increases, forming a mass on the surface of the body. The traditional method is to close the defect by pulling the edges together with a silk thread, but the result is often torn again due to high tension; the new method is like using a small piece of cloth to make a “patch” for the broken clothes, so that the clothes will be durable. This method is called tension-free mesh hernia repair because the suture is tension-free and the “patch” is a mesh of polypropylene material with good compatibility with human tissue.
Drawbacks of the traditional surgical approach
The most important disadvantage of the traditional surgery for hernia is that the incision area is painful after the surgery, the patient cannot get out of bed for three days after the surgery and has to walk bent over for a week after the surgery, and the recurrence rate is over 10%. In order to prevent recurrence, it is required to avoid heavy work and strenuous exercise for 3 months after the traditional surgery. The new method is to give a “patch” to the “broken hole”, “patch” material and human tissue between completely no tension, no obvious pain and discomfort after surgery, the day of surgery can be out of bed activities After the surgery, the patient can resume normal life and work 3-5 days after discharge, without any restriction on activities, and the recurrence rate of the surgery is reduced to less than 1 in 1,000.
The Department of Gastrointestinal Surgery of Wuhan Sixth Hospital is the first team in China to start tension-free mesh hernia repair, which has successfully cured thousands of patients with various types of hernia without a single case of recurrence, and the postoperative pain is mild and recovery is fast.
Recurrence of hernia remains high
Hernia is no less painful than tumor, and once trapped in the vicious cycle of treatment-recurrence-treatment, the pain continues and the patient suffers even more. Traditional hernia surgery, with its obvious postoperative pain and high recurrence rate, is rarely performed nowadays, and is replaced by tension-free mesh hernia repair. According to foreign reports, the recurrence rate of tension-free mesh hernia repair for hernia is less than one in a thousand; however, because of the large difference in the scale mastered by surgeons in China, this surgery with a very low recurrence rate still cannot break the “recurrence” barrier.
In recent time, Wuhan Sixth Hospital Gastrointestinal Surgery Department has admitted five or six cases of hernia recurrence, and almost every patient has a “blood and tears history”. 72-year-old Zhang Dad had performed mesh repair in a hospital, and after the surgery, he had stubborn pain at the incision site, and visited eight specialist clinics in seven hospitals, and each time he was either given drugs or local injection for pain relief. The pain was still not relieved after six months. The pain was completely relieved after another operation. 69-year-old Father Li had undergone four mesh repairs, each time relapsing about a month after the operation. Later, he was referred to the Gastrointestinal Surgery Department of Wuhan Sixth Hospital by Father Zhang, and the fifth operation made Father Li say goodbye to the pain of recurrence from then on.
The main reason for the recurrence of tension-free mesh hernia repair is that the “patch” is too small. In general, when hospitals do mesh repair, the size of the mesh cut is the same as the area of the “hole” in the abdominal wall, and after a long time, a gap appears between the edge of the “hole” and the mesh suture, from which the organs in the patient’s abdominal cavity will protrude again. The key to mesh repair of hernias is that the mesh must be cut 1-2 cm beyond the edge of the “hole”. This improvement is actually very easy for the doctor, but it relieves a lot of pain for the patient.
Several misconceptions in hernia treatment
A major misconception: Hernia can be treated without surgery
The root cause of a hernia is a “hole” in the abdominal wall tissue. A hernia is when the intra-abdominal pressure increases and an organ or tissue, such as the small intestine, protrudes through the “hole” and forms a mass on the surface of the body. Any hernia requires surgical “patching” as if it were a hole in a garment that must be “patched” with a small piece of cloth. The most effective one is currently recognized as the repair of the “hole” in the abdominal wall with a polypropylene mesh, called tension-free mesh hernia repair.
The 68-year-old father Shi, who was afraid of surgery after suffering from a hernia, listened to the advertisements to paste his belly button to cure the hernia and pasted it once a week for more than a month, but the hernia did not improve and his belly button became inflamed and pus filled.
The first thing you need to do is to get a hernia, and you will not want to have surgery, so you will have to go to a private hospital for injection. The doctor told him that the gel injected into his body could plug the “hole”, but after five injections of treatment, Dad Hu’s hernia remained the same. When he was determined to go to a regular hospital for treatment, the surgeon told him that the gum material in his body was found to be severely adherent, causing some tissues to coagulate and become necrotic. In order to remove these adhesions tissue, it would have taken only a few hours to get the minor surgery done, but it took three hours. What is even more unacceptable to Father Hu is that the doctor mistakenly injected the gel into the spermatic cord, resulting in ischemic necrosis of the testicles and irreversible testicular atrophy.
In addition, there are many patients who use hernia belt compression to prevent hernia protrusion. Although hernia belt compression can temporarily relieve the symptoms, it is not a permanent solution and brings a lot of inconvenience to daily life.
Two major misconceptions: Elderly hernia patients are not suitable for surgery
With the aging of the population, there are more and more elderly patients with hernia. Whether in outpatient clinics or on the telephone hotline, the most frequently asked question is whether elderly hernia patients can undergo surgery. There is a deep-rooted belief that surgery is inappropriate at an older age.
Before hernia surgery, the surgeon routinely assesses the patient’s ability to tolerate surgery. The first step is to understand the patient’s usual living conditions, such as whether he or she can take care of himself or herself, how many stairs he or she can go up, how active he or she is and how he or she sleeps, etc. The second step is to ask the patient what medical conditions he or she had in the past and then to do some selective tests with the aim of assessing organ function. In fact, elderly patients with hernia in their seventies and eighties can tolerate hernia repair surgery if they do not have serious medical diseases, can usually take care of themselves, and do not suffer from panic and chest tightness when going upstairs.
Three major misconceptions: laparoscopic hernia repair is a minimally invasive surgery
Most hernia surgeries can be completed under local anesthesia, the incision is not large, there is no obvious pain and discomfort, and the operation time is short (30-90 minutes), which is itself a minimally invasive surgery. Laparoscopic hernia repair is technically difficult, with significantly longer operating times and more serious consequences in case of complications. The bottom line is that laparoscopic hernia repair not only does not reduce surgical trauma, but also greatly increases the cost of surgery. Therefore, laparoscopic hernia repair is generally not needed for hernias, and conventional surgery can solve the problem.