Repairing A Hernia – Part 1

A hernia is a bulge due to bowel or fat from inside the abdomen protruding out through a weak area. The most common kind is an inguinal hernia in the groin. Above the ligament of the groin is a small hole, deep in the muscle wall of the abdomen, through which arteries and veins pass to the testicle. If this hole, or the area near to it becomes weak and stretched then a pocket (or sac) of the membrane lining the abdomen (the peritoneum) can bulge through. On standing, coughing or vigorous activity, the sac becomes filled with bowel or fat from within the abdomen.

Aching and discomfort can be caused by the bulge of the hernia but the protrusion generally returns back into the abdominal area when the person lies down, with the necessity to manually press it back into place at times. Aching can occur without any visible bulging and then a doctor’s examination is needed to find the hernia. A very longstanding hernia may develop into a very large protrusion, even going so far as to fill up a man’s scrotum. A very large hernia like this will likely remain protruded most of the time and be very difficult to relocate.

Women suffer inguinal hernias less commonly than men but a different kind of hernia, a femoral hernia, occurs more often in women than men and a doctor can diagnose this by examination. Femoral hernias are more typically repaired as a matter of course.

Hernias are usually troublesome only because they cause a bulge and aching whilst the most serious risk of a hernia is strangulation which means the bowel which becomes completely trapped and its blood supply may become cut off. The produces sudden severe pain and requires an urgent operation when the affected piece of bowel may need to be removed. Strangulation is not very common and many people have hernias for years without them ever becoming strangulated. Obstruction of the bowel can also occur it the bowel becomes trapped and this demands an operation even if the blood supply has not been cut off.

Hernias can only be permanently cured by operation, as leaving them may allow them to increase in size or at least remain as troublesome, although there is a small risk of strangulation and continued discomfort. A hernia does not have to be operated on if it is not causing undue symptoms and surgeons can discuss the pros and cons with their patients. To hold a troublesome hernia within the abdomen a truss can be used but it needs to be applied before a person gets up and the abdominal pressure increases on activity. Operation is a superior treatment for a hernia which is giving symptoms and being of advanced age or having medical complications should not prevent repair being performed due to safer general and local anaesthetics.

The surgeon performs the operative repair through an incision in the groin of approximately 12cm in length. The surgeon opens a muscle layer and turns their attention to the hernia sac, dividing off the sac from the tube to the testicle, arteries and veins. Bulging bowel or fat is pressed back into the abdomen and the surgeon either ties off the neck of the sac or stitches it back in.

The weakened area is then repaired and strengthened and the hole for the veins and arteries to the testicle is recreated back to its usual size. The hernia will be likely to return if it is not repaired, with surgeons typically using a plastic mesh which they stitch over the herniated area. Stitches can also be used without employing the mesh and this is more likely in femoral hernias. Good long term results have been shown with both techniques and the typical chance of hernia reoccurrence is 2%.

Some surgeons do the operation laparoscopically, under general anaesthetic. The telescope is inserted just below the tummy button and gas is introduced through the telescope to open up the space between the muscles in the lower part of the abdomen and groin. Two tiny 5mm incisions are made in the lower abdomen for further instruments to be inserted which are used to place a sheet of plastic mesh to repair the hernia.

Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapists in Kensington visit his website.