A COMPLETE GUIDE TO HERNIAS

Hernias are one of the most common medical conditions. Hernias are more prevalent in men than in women. Each year, more than one million Americans opt-in for hernia repair. Out of which 800,000 involve the inguinal hernia repair. Abdominal hernias, especially inguinal hernia, is more common than other types of hernia. Every 24 out of 100 men are likely to suffer from an inguinal hernia in their lifetime.

Hernias are initially asymptomatic but can easily be diagnosed clinically. There are many types of hernia, such as inguinal, femoral, umbilical, epigastric, incisional, Spigelian, and traumatic.

Hernia

A hernia is a bulging part of the internal organ or fatty tissue protruding out of the weakened opening in the muscular wall or fascia containing it.

Types of Hernias​

INGUINAL HERNIA

Inguinal hernia appears at the site of the groin extending into the scrotum. It is a bulge of internal tissue such as the intestine sticking out through a weakness in the abdominal wall. It may appear close to the groin. A lump can extend from the pubic tubercle into the scrotum.

It is main risk factor includes aging and increased pressure on the abdominal cavity. It is 75% more prevalent than any other abdominal hernia. It is most common in men than women, with an incidence rate of 28 per 100 000 in the US. It is congenital in young children and acquired among​​adults.

FEMORAL​ HERNIA

A femoral hernia is a rare acquired condition. It also takes place at the site of the groin. It is more prevalent in women than in men. It is more 5% prevalent than other abdominal hernias.

• ​ UMBILICAL​ HERNIA​

An umbilical hernia occurs near the belly button. It is 6-14% more prevalent among adults making it the second most common hernia. It is likely to occur in babies if the umbilical cord doesn’t close properly.

• ​ HIATAL​ HERNIA

In the hiatal hernia, the part of the stomach pushes through the weakness of the diaphragm and poke out in the chest. It is more common in men than in women. The exact cause of hiatus hernia is not known. However, age is one factor that might influence the weakness of the diaphragm, and straining on the tummy results in hiatus hernia.

EPIGASTRIC​ HERNIA

It occurs when the tissue sticks out of the abdominal wall between the belly button and the sternum.

INCISIONAL​ HERNIA

It occurs when a tissue of an organ sticks out at the site of the surgical incision. It might happen when the surgical wound does not heal properly. The other rare types of hernias are Spigelian hernia (occurs at Spigelian aponeurosis), diaphragmatic hernia (congenital disability of the diaphragm), and muscular hernia (muscle tissue protrusions)

Symptoms

Some of the hernias are asymptomatic such as an inguinal hernia. A patient may notice a bulge while standing or doing any physical activity that causes a hernia to appear. Most of the patients usually seek medical help when they experience chronic pain or a recurrent hernia.

Anyone with a hernia is likely to experience the following symptoms:

• The small bulge at the site of a hernia
• The appearance of hernias while coughing, lifting something, a bowel movement, or any other physical activity (which make the hernia to reappear)
• Bulge size increases over time
• Minimal discomfort
• Incarcerated hernia (which can’t be pushed back or reduced) can be painful​.​ If not treated, an incarcerated hernia can become strangulated.

Symptoms for strangulated hernia are

• Dragging and aching pain
• Nausea
• Vomiting
• Abdominal distention
• Persistent coughing
• Constipation
• Tender hernia
• Temperature
• Hiatal hernia symptoms are specified. They include:
• ​​Absence of bulge
• ​​Regurgitation, bloating or burping ·​ ​Shortness of breath
• ​Acid reflux ·​ ​Chest pain
• ​Difficulty swallowing food or drinks

If you are experiencing the above symptoms, please ​contact our Henderson clinic immediately and receive a consultation from Dr. Dasari.

Causes

The leading causes of hernias involve:

• Aging
• Obesity
• Straining due to lifting a heavy load
• Persistent coughing
• Giving birth
• Chronic bronchitis
• Intra Abdominal masses
• Enlarged prostate
• Distention Increased bowel sound
• Visible peristalsis etc.

Diagnosis

Most of the hernias can be clinically diagnosed on physical examination, but it may require an ultrasound and CT scan for confirmation. The hernias are so common, especially inguinal hernia, that even you may self-diagnose it, but it’s best to check and confirm with your doctor before making any conclusions. Initially, a lump is small and becomes more obvious when you cough or perform any strenuous exercise such as lifting.

A surgeon will initially examine your lump while you are standing. When you lie down, a surgeon may notice a reduction in the size of the bulge. The surgeon may also determine whether the hernia is indirect or direct. Furthermore, cough impulse helps demonstrate the hernia as well

Treatments

Non-surgical treatment

If the hernia is asymptomatic, your surgeon is likely to exercise watchful waiting. During this period, a surgeon may observe your hernia to make sure it can be pushed back and doesn’t grow in size and become painful.

While some surgeons recommend watchful waiting, others recommend early surgical repair to avoid any later obstruction or strangulation, especially in the case of femoral hernia.

Patients are likely to develop bowel strangulation after 2 years of diagnosed femoral hernia. ​In the case of hiatal hernia, anti-acid reflux medications are prescribed to relieve pain and discomfort. The specialist is in the best position to recommend the best possible solution.​Call us to book an appointment now.

Types of surgery

Although surgery is recommended based on the severity, size, location, and pain of hernia, there are two primary surgical options for hernia repair.

• open surgery
• laparoscopic operation

Each surgery has its benefits and may also carry some risks. Your doctor will thoroughly evaluate on a case by case basis regarding the whole procedure and post-complications (if any). The best option in your interest is then decided by your surgeon, depending on the condition of your hernia.

Open surgical repair​

In an open surgical repair, a surgeon may make a 5-inch incision at the location of a specific hernia. The bulge is put back into its place, and the weakened abdominal wall is closed via sutures, and mesh is added to help strengthen and support the weakened area.

Laparoscopic repair

Laparoscopic surgery may involve one incision of 1 inch in size or 2 incisions of 0.5 inches. Surgical instruments are inserted through the incisions. Mesh is added to support the weakened area of the abdominal wall.

Advantages of laparoscopic repair

The advantages of laparoscopic surgery over open surgery are:

• May have a faster recovery of 2 weeks.
• It may be less painful.
• May experience fewer complications.
• May get a same-day discharge for most of the patients.

Both surgeries’ recurrent rate is almost the same, but laparoscopic surgery may have fewer complications and associated risks. However, the specialist will be in the best position to decide what’s ideal for you.

Conclusion

All hernias are ultimately treated surgically. It is important to visit your local practice if you observe a bulge in the abdominal cavity. Your surgeon will decide the best course of treatment for you. Suffering from a hernia? Call our clinic today! (702) 602-6600