I. What is a hernia
A hernia is a weakness or dehiscence of the human abdominal muscle tissue causing the body’s tissues and organs, such as fatty tissue or intestinal tubes, to protrude outward through this location in the abdominal cavity and form a mass under the skin. The pressure generated by the tissue penetrating the weak area may cause discomfort or unbearable pain to the body. The symptoms of soreness and discomfort or pain may be more pronounced especially when there is pressure acting on this area, such as during prolonged standing, weight-bearing, physical activity, and large or small bowel movements.
Even if a hernia is only suspected, it is important to see a doctor promptly to avoid serious complications; a hernia can be fatal.
When you lie down or squeeze the protrusion under the skin, it is a reversible hernia and is not dangerous, but still needs to be judged by a doctor; if the protruding tissue is severely protruding and cannot be reverted to a flat state, it is a difficult hernia, which is usually painful and requires immediate action. Blood in the stool, constipation, severe pain, vomiting and even shock. Once these emergencies occur, immediate surgery is needed to loosen the embedded contents and repair the hernia, sometimes even removing part of the intestinal canal for enteroanastomosis or enterostomy. Even if a hernia is only suspected, it is important to see a doctor promptly to avoid serious complications.
Causes of hernia
The traditional view is that lifting heavy objects can cause a hernia, but in fact most hernias are due to a long-standing weak area in the body. Usually weak areas in the abdominal wall are inherent and become weak with age, trauma or surgical incisions. Lifting heavy objects or doing heavy physical work can exacerbate the development of a hernia.
Although hernias are more common in men than in women, they can occur in anyone, and there are many factors that predispose them to the disease, including movements or activities that add extra pressure to the abdominal wall
Actions or activities that add extra pressure to the abdominal wall, such as
Chronic cough, especially in smokers
Chronic obesity
pressure on the abdomen during urination and defecation
pregnancy
Abdominal pressure when lifting heavy objects
Persistent sneezing due to allergies, etc.
Often weak areas of the abdominal wall are inherent.
3. Are all hernias the same?
There are many types of hernias, which can be classified according to their location in the abdominal wall or their specific causes.
Common hernias include
Inguinal hernia: This is the most common type of hernia, accounting for 85% of all extra-abdominal hernias. Because this hernia appears in the inner ring of the abdominal wall, it is more likely to develop in men than in women. In males, this is the area of potential weakness when the testicles are prolapsed. When the area of weakness is located in the internal ring it can cause an inguinal hernia. If in males, the hernia sac will protrude toward the scrotum and in females it will protrude laterally.
Femoral hernia: It is more common in women, usually caused by pregnancy and childbirth, and is located on the medial thigh.
Incisional hernia: An incisional hernia appears at the site of a previous surgical incision and may slowly worsen weeks, months or even years after surgery.
Umbilical hernia: This hernia appears in the umbilicus where the body is naturally weaker because it is connected to the umbilicus and appears not only in adults but also in some infants and children at birth.
IV. Measures to take if you have a hernia
If you have a hernia, even if it does not seem serious, especially if you do not have any symptoms yet, it is important to seek medical attention immediately and determine a treatment plan. It is crucial that the hernia does not go away on its own, and if left unattended, it will only get worse and the resulting complications can be life-threatening.
The only way to treat a hernia is by surgery.
The only way to treat a hernia is to perform surgery. In fact, hernia repair is a common surgical procedure and, like any other surgery, there are risks involved in the hernia repair process that are gradually being managed and the discomfort felt by the body is minimized.
There are several types of hernia repair procedures available, and understanding each will help you discuss them with your surgeon, ask your questions, and choose the most appropriate treatment together.
V. Types of surgery
There are two main types of surgical procedures for hernia repair: tension repair and tension-free repair.
Tension repair.
When this method is applied, the surgeon will make an incision in the location of the abdominal hernia, restore the protruding tissue into the abdominal cavity, and then suture the hernia closed. Tension repair is usually used in children or in cases of very small hernias, but it has the following disadvantages: the recovery period after tension repair is longer, about 4-6 weeks, compared to tension-free repair, and the hernia recurrence rate after tension repair is 10-15%. The use of this procedure has been decreasing in recent years.
Tension-free repair.
There are several methods of tension-free repair, and the most commonly used methods are described below.
Flat mesh repair: After the incision is made, the surgeon sutures a flat mesh piece along the hernia above the protruding tissue. This method works well, with only a 3% recurrence rate. The recovery is quick and the body feels little discomfort. Moreover, the procedure can be performed under local anesthesia and the patient can remain awake, reducing the risks associated with general anesthesia. The only disadvantage is that if the hernia is large, the extensive suturing for reinforcement increases the risk of nerve damage and persistent postoperative pain in the operative area.
Filled mesh repair: this method is mostly used for inguinal hernias and the results are similar to those of a flat patch repair. The disadvantage is that it is not as effective as other methods in preventing the formation of a new hernia. There is also an increased likelihood of recurrent hernias or deviation of the tissue from its original position if the plugs shrink. Some patients may experience prolonged discomfort due to compression of the skin by the plug.
Laparoscopic repair: Laparoscopy makes “posterior hernia repair” possible. The surgeon inserts a tube device with a magnifying lens, called a laparoscope, through a small incision into the abdomen to detect the hernia and precisely place the flat mesh on the inside of the abdominal wall, rather than on the outside of the abdominal wall as in a traditional repair. The advantage of a retro-abdominal repair is that the pressure inside the abdominal cavity helps to hold the flat piece in place. Laparoscopic repair requires general anesthesia, which is the greatest risk of the procedure, and also takes longer.
Ring mesh repair: This is another type of posterior repair. This mesh has a fixed external ring wrap that helps to hold the mesh in place in the hernia area, has few sutures, and can be performed under local anesthesia or epidural anesthesia. The disadvantage is that the structure of this mesh, the external ring, can sometimes cause pain and discomfort after the procedure. In addition, it is difficult to determine whether the mesh is properly opened because it is difficult to observe the mesh once it is positioned.
VI. Postoperative precautions
In most cases. There will be pain and discomfort for the first few days, which is related to the patient’s physical condition before surgery and the size of the hernia and the surgical approach. The surgeon may give the patient some painkillers and antibiotics. As with any surgery, there is a risk of complications with hernia repair. If abnormal symptoms occur after surgery, such as bleeding, increased pain, dizziness, fever, difficulty passing urine, abdominal distention, it may be an infection or other problem, and the doctor should be informed promptly.