Health Knowledge New Concepts in Treating Hernias How do you know you have a hernia? Generally, hernias are easy to detect. Areas that are prone to hernias are the groin, belly button and incisions that have been operated on. The patient may see a bulge in the skin of the abdominal wall or may feel pain when he lifts heavy objects, coughs, urinates or defecates forcefully, or stands or sits for long periods of time. The pain may feel sharp and quick or it may be a constant dull ache. If you have severe or persistent pain, or redness at the hernia, or if you are prone to tenderness, seek immediate medical attention, as this may be a sign of an incarcerated hernia (where the bowel or other tissues are stuck) or strangulation. What are the causes of hernias? Some parts of the abdominal wall are born with potentially weak parts (natural weakness in the area of the pubic ramus, the source of inguinal hernias). Due to old age, injury, old surgical incisions, or congenital skin weakness, the abdominal wall can develop a hernia from the weak area (or elsewhere) under pressure. Anyone of any age can develop a hernia, but most childhood hernias are congenital. In adults, hernias are either due to a congenital weakness in the abdomen, or the abdominal wall becomes weak to the point of tearing due to heavy weights, persistent coughing, or difficulty urinating or passing stool. How are hernias treated? Surgery is currently the only effective treatment for hernias. There are two main types of surgery: traditional tension repair and modern tension-free repair. Tension repair (blunt tissue repair) is to pull together the tissue around the defect itself and sew it up to repair it. The procedure has many disadvantages, specifically postoperative pain, high recurrence rate, fasting, and having to lie in bed for days, and not being able to move around for three months, and many patients can’t even straighten out their backs. In particular, the recurrence rate is relatively high, can reach 10~15. Tension-free repair is the use of biological materials for tension-free mountain repair, in line with the human anatomy, small trauma, light pain, fast recovery, low recurrence, has gradually become the preferred method of inguinal hernia repair. At present, there are three commonly used open tension-free repair methods: flat piece tension-free repair method (Lichtenstein surgery): Lichtenstein surgery is the patch and inguinal canal wall suture, spermatic cord through the patch perforation lead out. It is characterized by fewer foreign bodies and simple operation, and is suitable for hiatal and rectal hernias with small defects. Hernia ring filling tension-free mountain repair method: this procedure is a combination of mesh plug filling and Lichtenstein’s surgery, that is, using polypropylene rolled into an umbrella to fill the defect of the mountain ring, and then using a flat piece to strengthen the posterior inguinal wall, which is a popular hernia repair abroad at present. It is characterized by simple operation, foreign body sensation and persistent chronic pain in patients, and is not suitable for larger inguinal hernia and joint hernia. Preperitoneal interspace repair method: this procedure is the concept of total inguinal repair, the patch is placed in the preperitoneal interspace to repair the pubococcygeal foramen, a one-time overall repair of the three potential defects of the good straight hernia, hiatal hernia and femoral hernia, to minimize the recurrence of hernia. The procedure applies PHS/UHS, a stereotyped product produced by Johnson & Johnson, which has three parts: a bottom sheet placed in front of the peritoneum to repair the pubococcygeal orifice; a plug-like intermediate to repair the hernia ring; and a surface sheet to repair the posterior wall of the inguinal canal. It is characterized by triple repair, safety and reliability, less foreign body sensation, quick recovery, and is the hernia repair technique with the lowest recurrence rate.