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Hernias

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Each year, more than half a million patients undergo hernia repairs in the United States. A hernia is a defect which occurs when the contents of one of the body cavities bulges out of the area where they normally are contained. The contents are usually parts of the intestines or fatty tissue from the abdominal area called “omentum,” and are enclosed in a thin membrane that lines the inside of the cavity naturally. While hernias sometimes produce no symptoms, they can also cause severe pain and require immediate surgical care. Almost all hernias have the risk of strangulation, meaning their blood supply is cut off as a loop of the intestines is trapped. This can happen by the content of the hernia bulging out and the opening applying sufficient pressure so that the blood vessels are too constricted to supply enough blood. If this happens, it becomes a serious medical and surgical emergency because the tissues require oxygen provided from blood flow.

Hernia Contributors and Symptoms

There are various contributors and factors that can cause hernias. Some of them may include:

  • Heredity - If close family members have been diagnosed with hernias, your risk increases.
  • Gender - Men are far more likely to develop inguinal hernias than women. Most of the newborns and children diagnosed with hernias are boys.
  • Obesity - This puts extra pressure on the abdomen.
  • Frequent constipation - Straining during bowel movement can lead to inguinal hernias.
  • Chronic cough - Straining from coughing increases the chance of developing an inguinal hernia.
  • Premature birth - Infants, particularly males, are likely to develop inguinal hernias.

You should see a doctor if you have a painful or noticeable bulge in the groin area. This bulge is probably more noticeable when standing up than when you’re lying down, and may grow bigger over time. You may experience pain when you lift heavy objects, cough, and strain during bowel movements or during long periods of standing up or sitting.

If your hernia does not flatten as you’re lying down, then the contents of the hernia may be trapped, which is known as an incarcerated hernia, leading to an intestinal blockage. If the intestines become too tightly trapped, then the blood supply to the gut becomes blocked and the intestines become gangrenous (die), which is sometimes called a strangulated hernia. Symptoms associated with a strangulated hernia include abdominal distention, persistent pain, vomiting, and change in pigmentation at the hernia site. Seek immediate medical care if you notice any of these symptoms.

Surgical Intervention and Hernia Repairs

As the second leading cause of intestinal obstruction, nearly every hernia must be surgically repaired to avoid the risk of incarceration (being trapped in the abdominal wall) or strangulation of the intestine or other organs..

Hernia repairs at West Medical are performed under regional or general anesthesia in an outpatient setting.

Types of Hernias

Inguinal hernias are located in the groin and account for 75 percent of all abdominal-wall hernia cases. They are 25 times more common in men than women. They can either be present at birth or acquired through coughing, heavy lifting, straining from constipation or a prostrate which is enlarged. Untreated hernias can become strangulated and lead to bowel obstruction if left untreated. Unless there is a significant medical condition to prevent it, all hernias must be repaired by surgical intervention.

Indirect Inguinal Hernia

People who have this type of hernia experience a pain or bulge in the groin region. This type of hernia follows the pathway that the testicles made before dropping into the scrotum during fetal development. This pathway should close shortly after birth but can become a site for a hernia later on. This type of hernia can be diagnosed at any age.

Direct Inguinal Hernia

Males are ten to 20 times more likely to get a direct inguinal hernia, which occurs when the organ enters through a weak spot in the area of the lower abdomen located above where the abdomen meets the thigh. This type of hernia is more likely to occur in the elderly, because their abdominal walls are significantly weaker.

Sliding Inguinal Hernia

This variant is seen in three percent of hernia cases, and occurs when the wall of the hernia sac is an organ similar to the bladder and colon. In these cases, your surgeon will take great care to avoid visceral damage to the organ involved during repair.

Pantaloon Hernia

This occurs when a direct and indirect hernia both develop on the same side of the groin. They resemble a pair of pants from the 17th century because the hernia sacs are divided by the epigastric vessels. Patients with pantaloon hernias are at a great risk to develop hernias in the future.

Bilateral Hernia

When hernias develop on both sides of the groin, they are bilateral hernias. This type of hernia is generally found in children but it also associate with age and straining in elderly men. Patients who develop a left inguinal hernia have a 25 percent chance of developing an occult right inguinal hernia. However, those with a right hernia only have a 10 percent risk of developing one on the left. A physical exam is often necessary to diagnose this kind of hernia as it may not display the typical symptoms of pain or a bulge. Bilateral hernias can be treated laparoscopically.

Thigh (Femoral) Hernia

These hernias are more likely to be found in women than in men. They carry a higher risk of incarcerating the small bowel which could then become strangulated which could become a life-threatening condition. Patients who develop this type of hernia may feel a tender bulge in the upper area of the thigh just under the groin region.

Epigastric Hernia

Approximately five percent of hernias are epigastric. This happens when fat breaks through the tissue. It is repaired by removing the fat and then closing the tissue weakness. The symptoms of this hernia include a painful bulge in the abdominal region.

Umbilical Hernia

This type of hernia is common in premature infants and elderly men. It can develop at birth if the umbilical cord fails to close completely during the development of the fetus. It can also be acquired through other health complications like cirrhosis, obesity, malnutrition, kidney failure or heart failure.

Incisional Hernia

Found in 10 percent of hernia cases, the incisional hernia occurs when the incision from a past surgery breaks down and an abdominal structure such as the liver, intestine or fat emerge through the weakened tissue and make a hernia. It is slightly more common in men than women.

Spigelian Hernia

Most commonly found in men over 50 years of age, these hernias are located below the navel to the side of the abdominal muscles. This hernia presents with a painful bulge in the abdominal area.

Obturator Hernia

This hernia is nine times more likely to occur in elderly women and can be fatal if left untreated. It is typically found in the pelvic area and is very rare.

Treatments

There are two types of hernia operations:

Herniorrhaphy

This is also called an open hernia repair surgery and has been the traditional method for more than 100 years. It requires a long incision in the groin area in order to push the protruding intestine back into the abdomen. The weakened or torn muscle is repaired by sewing it together. Usually the weak area is reinforced and supported by a synthetic mesh, called a hernioplasty. This reduces of the risk of the hernia recurring.

Laparoscopy

This type of hernia operation has been developed in the past decade. Rather than using one long incision, the surgeon will use several small incisions for the laparoscope. A tiny camera is inserted through a fiber-optic tube through the abdomen in order to guide the surgeon with a video camera. Then, a hernioplasty is performed by using synthetic mesh over the weakened area.

The advantages of laparoscopic hernia repair include less discomfort and minimal scarring. Typically, people return to work within a few days. Disadvantages include the increased risk of developing complication and hernia recurrence, but this risk is reduced by seeing a skilled, experienced surgeon.

Hernia Treatment Risks and Complications

  • Reaction to anesthesia - As with any general surgery, this is a risk of a serious reaction or death resulting from anesthesia.
  • Infection or bleeding -The site of the hernia may bleed or become infected.
  • Scar formation at the site of the hernia repair.
  • Persistent postoperative pain or numbness in the groin or thigh.
  • Damage to the femoral artery or vein - This is a risk during femoral hernia surgery.
  • Male infertility - Although very rare, damage to the vas deferens (the cord that carries sperm from the testicles to the penis) can result in the inability to father children. The testicles may also be damaged, as well as testicular function.
  • Need for revisional surgery, which is less likely if a hernia is being prepared by an experienced surgeon performing laparoscopic surgery.
  • Hernias may recur in 1 to 10 out of 100 hernia repair surgeries, but the use of mesh to repair weak stomach muscles decreases the likelihood of the hernia recurring by more than half.
  • Death, heart attack or stroke have been reported at or near the time of hernia repair surgery, but the risk of these occurring is extremely low.

After Hernia Treatment

Immediately following the procedure, you will be transferred to a recovery room to be monitored until your anesthesia wears off and you are alert. Once you are fully awake, you can be discharged if there are no complications noted. Expect to feel some soreness during the first 48 hours after your operation, which can be managed with prescribed narcotic pain medication. If you have prolonged soreness and feel no relief from the prescribed medication, you must notify your surgeon.

As you are in the process of healing, start to take short walks as soon as possible in order to help blood circulation and prevent blood clots forming in the leg veins. Depending on the type of hernia repair you undergo, you may be able to return to work within a few days after your surgery if you have had an uncomplicated operation and your job is of a sedentary nature. Other jobs, especially if they are physical in nature and require heavy physical lifting, require a lengthier healing period of several weeks so you are fully healed to perform such duties. After two weeks, you will have a follow up appointment with your surgeon to monitor your healing progress.

Hernias are complex and have many different aspects to them. Don't let hernias stop you from living your life. The doctors at West Medical are happy to help you diagnosis and treat your case. If you are interested in learning more about the causes, symptoms, and treatment costs for hernias, please call West Medical at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.

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