1. What is a hernia?
A hernia is when an organ or tissue in the body leaves its normal anatomical site and enters another site through a congenital or acquired weak spot, defect or gap. The pressure generated by the tissue penetrating the weak area can cause discomfort and great pain to the body. The pain is especially noticeable when pressure is applied to the area, such as when standing for long periods of time, urinating or defecating, or lifting heavy objects. When you lie down or squeeze the subcutaneous protrusion, it is an eradicable hernia and is not immediately dangerous, but still needs to be judged by a doctor; if the protruding part of the tissue is severely protruding and does not return to a flat state, it is a non-eradicable hernia, which is usually painful and requires immediate action, and also indicates that part of the intestine may be tightly embedded, forming an incarcerated hernia, in which case a stoppage of the intestine will occur and there will be In this case, there will be a stoppage of the intestine, blood in the stool, fever, constipation, severe pain, vomiting and even shock. In the event of these emergencies, immediate surgery is required to remove the obstruction and repair the hernia. Even if a hernia is only suspected, it is important to seek prompt medical attention to avoid serious complications.
Diagram of a hernia
2. How do I know I have a hernia?
The areas prone to hernias are the groin, belly button, and incisions at the site of previous surgery. Generally speaking, hernias are easy to detect. You will see a bulge in the skin of the abdominal wall; when you lift heavy objects, cough, forcefully urinate or defecate, or stand for a long time, you will find that the bulge increases in size or feel pain.
3.What are the classifications of hernia?
According to the location of the mass hernia can be classified as inguinal hernia, femoral hernia, incisional hernia, parastomal hernia, umbilical hernia, white line hernia, etc. Inguinal hernia is the most common and is called “small intestine hernia” by the common people. As shown in the picture.
4. How to treat a hernia?
Adult hernias do not disappear on their own over time. Once diagnosed, any type of adult hernia should be operated on as soon as possible if there are no contraindications. It is recognized worldwide that the only effective and reliable treatment for hernias is surgery.
5. Is medication and injection therapy effective?
Hernia is also unlikely to be cured by medication. There is no medication that can effectively repair abdominal wall defects. Injection therapy for hernia is also very difficult to achieve repair effect, and it is very easy to cause serious medical accidents such as intestinal adhesions, intestinal leakage and lower limb vascular blockage due to inaccurate injection sites. Therefore, the treatment of hernia by injection is not advisable.
6.What are the main methods of hernia repair?
There are two main types of hernia repair in adults: namely, traditional suture repair and tension-free repair. Traditional suture repair, or tension repair, is a repair method in which the defective tissue is pulled together and sutured. This method has high tension, slow postoperative recovery, long bed rest, high pain, and a high recurrence rate. Tension-free repair is hernia repair with hernia repair material, which has the advantages of conforming to human anatomy, less injury, less pain, shorter operation time, faster patient recovery and lower recurrence rate, and is currently the preferred method for inguinal hernia repair.
7.What methods are now used for hernia treatment in Jiangsu Provincial Geriatric Hospital?
The method currently used in our hernia center for inguinal hernia is basically tension-free hernia repair under local infiltration anesthesia. Local anesthesia has many advantages, such as high safety, short operation time, low cost, mild postoperative pain, low systemic impact, and the ability to eat and move around after surgery. Tension-free hernia repair has the advantages of conforming to human anatomy, good safety, less injury, less pain, shorter operation time, quicker patient recovery, and lower recurrence rate. Our center also takes the lead in widely carrying out day surgery, which can greatly save patients’ time and reduce their economic burden.
8.Is inguinal hernia repair a minor surgery?
Inguinal hernia is a common and frequent disease, and inguinal hernia repair is one of the most routine and important surgical procedures, but it is not a “minor surgery”, it is a typical anatomical surgery and is regarded as a model of perfect combination of anatomy and surgery. It must be performed by a surgeon with specialized training.
In Europe and the United States, there are specialized training centers where physicians with thousands of surgical operations are responsible for training. Only surgeons who have undergone rigorous training and received a certificate of competence are allowed to perform the operation of tension-free hernia surgery.
9.What should I pay attention to during incisional hernia surgery?
Incisional hernia surgery is a very specialized surgery. Patients should try to choose a large hospital for consultation. Incisional hernia surgery involves correction of the problems of the previous surgery, treatment of the huge hernia contents, monitoring of the patient’s cardiopulmonary function, selection of the repair material, correct placement of the material, etc. Both the patient and the surgeon should pay sufficient attention to these issues.
10.What are the misconceptions of patients about hernia surgery?
Hernia is a common disease with an estimated prevalence of 3% in the general population and a male to female ratio of :
12:1, with 6-8% of the male population suffering from varying degrees of inguinal hernia, especially in the elderly and children. However, many patients lack knowledge about hernia disease and there are many misconceptions that prevent timely treatment for a long time. Many hernia patients are found by chance with a mass in the abdominal wall and a feeling of swelling. The development process of hernia is generally a slow one, starting with more nervousness but appearing from time to time and disappearing most of the time automatically after lying down, and the symptoms disappear, and over time the fear becomes indifference, unaware that the disease is slowly aggravating.
As the disease progresses, the hernia becomes larger and larger, the prolapsed intestinal tube becomes larger and larger, the symptoms become more and more obvious, the discomfort of abdominal cramping or dull pain gradually becomes obvious, and the patient feels inconvenient to move around, so the patient may be reluctant to go out and activities and the quality of life decreases. If the mass suddenly fails to retract and is accompanied by severe pain, the hernia may be ingrown, and once the hernia is ingrown, it has less chance to retract on its own. In most patients, the symptoms will gradually worsen, and if left untreated, it may further develop into a strangulated hernia. At this time, the intestinal canal will become necrotic due to lack of blood flow. If not treated in time, the patient’s life will be endangered, so a hernia should not be ignored and should be treated early. We have seen many misconceptions and lessons in the treatment of hernia in many patients in the clinic, and we summarize a few points to help patients raise awareness.
Firstly, they adopt an indifferent attitude towards hernia and are not actively treated. Many patients think that hernias are not painful and do not delay eating or drinking and do not need treatment, not knowing that the hernia will get bigger and bigger as the disease lengthens and the hole will only get bigger if the broken clothes are not repaired in time. I once saw a patient with a history of only two years, but the hernia was already bigger than a soccer and she could only lie in bed, and it was very difficult to take care of herself, not to mention the quality of life. Once the hernia is ingrown, it will be life-threatening and most of them need emergency surgery, and the risk of surgery will be greatly increased, so surgery should be performed as early as possible.
The second hope is that conservative treatment is effective. Conservative treatment can only temporarily relieve the symptoms, and no medicine or hernia belt can cure a hernia, which is a physical defect of the abdominal wall, and surgery is the single most effective way to treat a hernia. We have seen many patients with failed injections for hernias, which cost a lot of money and can cause anatomical unclearness of the surgical site, making surgery difficult.
The third fear is surgery. Most hernia patients have never had surgery in their lives and have a fear of surgery. Although surgery is an invasive treatment, most of them only require local anesthesia. Our minimally invasive method, with an incision of only about 5 cm, has very little damage, fast recovery, no need for catheterization and fasting, and discharge from the hospital in 1-2 days after surgery. Our “day surgery” has a shorter hospital stay and is more economical.
The fourth fear of recurrence is that modern tension-free hernia repair has significantly reduced the recurrence rate from more than 10% in the past to less than 1% compared with traditional hernia repair. Modern hernia surgery is developing rapidly, and hernia specialists can choose more reasonable repair materials and surgical methods according to the condition of different patients, and the recurrence rate of surgery is even lower.
Fifthly, there is a fear of foreign body reaction. Modern tension-free hernia repair uses organic materials to repair defects in the abdominal wall, so there is a common concern among hernia patients as to whether this material will cause harm to the body. Most of the repair materials used now are high-purity polypropylene materials, which are very inert, not easily chemically reactive with tissues, have good histocompatibility, and have been used in humans for more than 50 years.
The sixth fear of spending money, hernia mostly occurs in the elderly, when most patients have retired and their income is reduced, but most of the repair materials are now reimbursable, so patients only have to bear a very small amount of medical costs, which is completely acceptable to most patients.
The seventh embarrassment to see a doctor, some elderly patients, the external genitalia found near the mass, unwilling to inform their families, also unwilling to seek medical treatment, to get by, to suffer in silence. Only when an incarcerated hernia occurs do they go to the emergency room, which is not only painful, but also has a high risk of surgery and failure.
In conclusion, hernia patients should pay attention to hernia, get out of the misunderstanding and treat it early. Modern tension-free hernia repair is a minimally invasive and safe treatment method, and the success rate of hernia repair by hernia specialists is close to 100%.
11.What are the precautions for patients?
1. Please go to the Department of Pediatric Surgery for pediatric hernia and talk about the attending physician who is only responsible for adult hernia for the time being.
2. Basically, local anesthesia is used for inguinal hernia in our center, and you can eat and move around after surgery, but you should avoid strenuous exercise and heavy physical labor for 3 months.