Hernias
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A hernia is a protrusion of an organ through the body wall that normally contains it. Approximately 90,000 hernia repairs are performed in Australia every year. Hernias are classified according to their location and whether or not they occur spontaneously (primary hernias) or as a result of previous surgery (incisional hernias) or trauma. The most common type of hernias arise in the groin- these include inguinal and femoral hernias. The important risk factors for developing a hernia include: male sex, increasing age, a family history of hernias and patients with connective tissue diseases.
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Inguinal hernia:
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An inguinal hernia occurs through an abnormal communication between the abdomen and groin region. These type of hernias most commonly involve fat but sometimes the bowel or the bladder can be incarcerated. When this happens, the hernia may result in a blockage of the bowel or bladder, requiring an emergency operation.
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Femoral hernia:
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A femoral hernia occurs through a widening in the space of the upper thigh next to the major blood vessels and nerves of the thigh. These hernias most commonly occur in women and not uncommonly occur with obstruction.
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Ventral and umbilical hernias:
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A ventral hernia is any hernia that occurs through the front part of the abdomen and an umbilical hernia occurs through a defect in the belly button. These are common hernias that can be present at birth, develop over time due to increased abdominal pressure or as a result of previous surgery.
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Incisional hernia:
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Incisional hernias are hernias that occur at the site of previous surgical scars. These scars represent a site of inherent weakness in the tissue at that site.
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TREATMENT:
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The natural course for all hernias is to increase in size over time and the treatment for hernias is surgical repair.
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Groin hernias
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The gold standard treatment is laparoscopic ("key hole") surgery. This usually involves 3 small cuts in the lower abdomen where the hernia is repaired within the wall of the groin. Occasionally, an open surgical repair might be performed if there are concerns of significant scar tissue due to previous surgery or trauma. A mesh is used to reinforce the surgical repair and reduce the rates of future hernia recurrence.
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Ventral, incisional and umbilical hernias
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Simple umbilical hernias are frequently repaired with a small cut around the umbilicus where mesh is placed below the defect and the defect is closed over the mesh. For more complex hernias or multiple ventral hernias, both open and laparoscopic approaches can be utilised in conjunction with mesh. The benefit of laparoscopic surgery is improved recovery time, less pain and faster return to work. Occasionally, other techniques should be utilised for more complex hernias.
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