What are the causes of hernia? What are the best ways to treat a hernia? If a hernia is treated surgically, will it recur? Do you know the answers to all these questions? If you are not clear, you may want to take a look at my introduction for you.
1. What is a hernia?
Hernia is also called hernia or small intestine gas. Simply put, a hernia is a tear or hole in the muscle tissue of the abdominal wall, through which an organ or tissue such as the patient’s small intestine or omentum leaves its original position and protrudes into other parts of the body. Just like a car tire, the outer tire is broken and the inner tire protrudes through the hole.
2. What are the causes of hernia formation?
The cause of a hernia is related to the weakening of the abdominal wall and the high intra-abdominal pressure in the area. The weakened abdominal wall is further divided into congenital and acquired, with congenital deficiencies such as unclosed peritoneal sheath, incomplete umbilical ring atresia, white line defect of the abdominal wall, or wide inguinal triangle, etc. Acquired causes include surgical incision, trauma, inflammation, infection, etc. There are many factors that cause increased abdominal pressure, such as chronic cough, constipation, difficulty in urination, ascites, pregnancy, and frequent howling in young children.
3.How do I know if I have a hernia?
There are several types of hernias, but inguinal hernias are the most common. In the case of an inguinal hernia, the symptom is usually a bulge in the inguinal area accompanied by pain and a feeling of swelling. Sometimes the bulge disappears spontaneously when the patient is lying down, or when pushed by hand. Sometimes, the bulge does not disappear.
4. What should I do if I suspect I have a hernia?
The best way to determine if you have a hernia is to go to the hospital.
5. What should I do if I am diagnosed with a hernia?
According to official information from the American Academy of Family Physicians, hernias do not heal on their own, except in some children. In fact, for adult patients, surgery is the only effective treatment for hernias.
6. Can a hernia be cured by other methods without surgery?
Adult hernia is not self-healing and must be treated by surgery early. In infants and children under half an age, surgery can be suspended because the abdominal muscles of infants and children can grow stronger with the growth of the body and the hernia may disappear on its own.
For adult hernia patients, surgery is the only treatment option in foreign countries. In China there are many other methods such as Chinese herbal medicine applied externally and taken internally that are promoted, and many patients take some non-surgical methods for hernia treatment. However, from the perspective of modern surgery, since a hernia is a weak, defective or broken hole in human tissue, surgical repair is the effective treatment. The reasoning is the same as a tire needs to be repaired when it is broken or a dress needs to be repaired when it is torn.
7.What are the surgical methods of hernia repair?
The surgical treatment of hernia can be grouped into four main categories.
The first category is the traditional surgical approach. The main type of repair is tension repair, in which the torn tissue, i.e., the edges of the hole, is pulled hard together and sutured directly. This type of repair is often referred to as a tension repair. Tension surgery is like sewing up a tire with thread directly after the hole is broken, there is tension in the suture, there is a tendency to separate to both sides, and one of the sides is muscle, the postoperative pain is obvious and lasts for a long time, because it cannot withstand the long tearing, the repaired hole is easy to burst open again, and a hole appears again, leading to recurrence. The recurrence rate of tension surgery is more than 10-20%, according to domestic and international data. This type of surgery is more suitable for juvenile patients. In recent years, low-tension repairs applying own tissue have also been introduced. The main one is the Desarda procedure. This procedure applies an undetached extra-abdominal oblique tendon sheet to repair the posterior wall of the inguinal canal, enhancing the inguinal ring shutter (Shutter) and sling (Sling) closure mechanisms to achieve a physiologic repair. It is currently used less frequently. It is most suitable for young patients with a small hernia defect, patients with an incarcerated hernia with a high risk of infection, and patients who do not want a foreign body in their body.
The second type of surgical approach is laparoscopic. The surgeon uses different surgical instruments to insert a patch into the patient’s abdominal cavity or the anterior peritoneal space with the help of a video camera. The surgeon performs the surgery by imaging on a television screen. This type of surgery has good recent results, but is more expensive and has the potential for rare and serious complications such as intestinal obstruction and large vessel damage. This type of surgery is more suitable for patients with bilateral hernias of short duration.
The third type is the tension-free hernia repair with artificial material or called tension-free hernioplasty. Tension-free hernia repair was invented in 1984 by Dr. Lichtenstein and his associates at the Lichtenstein Hernia Center in the United States. The method involves covering the hernia defect with a patch with mesh that is highly compatible with human tissue. The logic of this method is equivalent to using silk to patch a hole in a silk dress. This method was named Lichtenstein’s surgical approach. This method has gained wide popularity because of its low recurrence rate, few complications, rapid postoperative recovery, and low cost. Lichtenstein’s tension-free hernia repair has been honored by the American College of Physicians as the gold standard in hernia repair surgery, and the center’s current director, Dr. Amid, has become president of the American Hernia Society as a result. Since the invention of tension-free hernia repair at the Lippincott Hernia Center, there has been a proliferation of approaches to hernia repair using various materials. All of these methods are supported by different theories. But basically, they all differ in the shape of the repair material. Tension-free hernia repair is done with both mesh plugs and mesh materials. The coverage of the defect can be in front of the transverse abdominal fascia or in front of the peritoneum.
The fourth type is the minimally invasive three-dimensional tension-free repair, which I was one of the first few surgeons to perform in China. This procedure is further improved on the basis of tension-free repair, and the operation is further minimally invasive, with the surgical incision reduced from 6-8 cm to 3-4 cm in general tension-free repair, and importantly, the operation within the incision is also improved in detail, and the repair is fully adapted to the three-dimensional space of the inguinal region. It is the most advanced procedure in the world at present, with minimal postoperative pain, accelerated recovery and excellent results.
The fifth category is the hybrid surgery combining open small incision and lumpectomy techniques, which has the advantages of both open and lumpectomy surgery and is suitable for inguinal hernia with good general condition and large or obese hernia sac.
Above Photo of minimally invasive 3D tension-free repair incision
8. There are many ways to repair a hernia, which hernia surgery should I choose?
It is the patient’s right to discuss his or her surgical options with the surgeon. Patients should take full advantage of this right. Different repair options are appropriate for different populations, and it is not possible to generalize that one surgical option is appropriate for all hernia patients. A pediatric patient may be best suited for a high ligation of the hernia sac. Adult patients, on the other hand, require repair surgery, and in terms of recurrence rates and the patient’s quality of life after surgery, surgery with a tension-free hernia is preferable to traditional surgery that simply sews the tissue together. Currently, minimally invasive three-dimensional tension-free repair is the best procedure to treat inguinal hernias in adults. Hybrid surgery is also an option for inguinal hernias with better general condition, larger hernia sacs or more obesity.
9.If I decide to have hernia surgery, what hospital and what doctor should I choose?
In China, the treatment of hernia has not been given enough attention in the past due to the poor health care awareness of people. The vast majority of hospitals do not have hernia specialists and the surgery is usually done by general surgeons. Many small and medium-sized hospitals are doing hernia surgery, and even some township hospitals do hernia surgery. In this condition, the quality of hernia surgery is difficult to guarantee. Although hernia surgery is not big, it is not a “small” surgery that can be taken lightly, but a surgery that has to be “opened carefully”, in fact, the appearance of hernia is very different, and the vas deferens and blood vessels need to be protected, and possible complications include testicular ischemia and atrophy The possible complications include testicular ischemia and atrophy, vas deferens damage, recurrence, hematoma, infection, chronic pain, etc. Care must be taken to achieve minimal postoperative complications, avoid serious complications, and recover quickly.
According to reports from around the world, there is a significant difference in recurrence and complication rates between hernia specialists and general surgeons. The recurrence rate of tension-free repair surgery performed by hernia specialists is around 0.1%, while the recurrence rate of surgery performed by surgeons who are not hernia specialists can be 2-5%. So look for a surgeon who is experienced in hernia surgery! Because of the many variations of hernias, many surgeons can perform a hernia surgery with a passing score of 60, but it takes a lot of experience to get it close to perfection. You have the right to ask your surgeon about his or her experience, the average number of hernia surgeries per month, and whether he or she performed the entire surgery himself or herself. To ensure the quality of hernia surgery and to minimize the occurrence of complications after hernia surgery, it is generally best not to choose a hospital that is too small, and a hernia treatment specialist with expertise in hernia at a medium or large hospital should be the best choice.
10.Will the hernia recur after surgery?
Traditional tension repair. Tension is created by sewing the tissues together, and the tension tears the tissues along the edge of the suture, which can easily lead to recurrence of the hernia. Therefore, the recurrence rate of traditional surgery is more than 10-20%.
Laparoscopic approach. Depending on the surgeon’s experience and skill level, the recurrence rate after laparoscopic repair of a hernia can range from 0.5% to 11%.
Tension-free artificial material repair. The recurrence rate of tension-free repairs performed by hernia specialists is reported to be around 0.1% worldwide. The recurrence rate of tension-free hernia repair by non-expert surgeons is between 2% and 5%.
11. How long does it take to recover from hernia repair surgery?
Conventional method (tension method, i.e. no patching, just pulling up the tissue on both sides of the defect and suturing it): the pain lasts for several weeks after the repair. It takes 4 to 6 weeks for the sutured tissue to heal.
Tension-free repair and laparoscopic repair: the tissues are not pulled together and sutured together, so the postoperative pain is milder and shorter, and the patient is usually discharged 7 days after surgery.
Minimally invasive 3D tension-free repair: the fastest recovery, generally patients can be discharged 3 days after surgery and can resume light physical work in 1 week.
12.What to pay attention to after hernia surgery (what to pay attention to after hernia surgery)?
1. You can get out of bed the day after hernia surgery.
2. If you cough, vomit or sneeze after surgery, you can press your hand on the wound to reduce the pain.
3. It is advisable to keep the wound dry after surgery and do not touch water until the stitches are removed.
4. You should not engage in strenuous exercise, lifting heavy objects, bending hard or riding a bicycle for 3 months after hernia surgery.
5.Practice a regular routine and avoid constipation, cold and cough to avoid increasing abdominal pressure.
6.If you are an adult, you can resume sexual life 2 weeks after surgery.
7.If there is inflammation such as wound redness, swelling and pain or swelling of the affected area, you should return to the hospital immediately for examination.