Hernias

Hernias

Hernias are abnormal conditions where structures confined to one anatomical place protrude out or into another adjacent anatomical place through a muscle weakness or defect. Hernias can be congenital (i.e. from birth) or acquired. Hernias can be internal or external. Hernias can be seen at any age and can affect both sexes. Contents protruding through the defect depend on the location. The most common among them are the intestines or the omentum (a curtain of fat inside the abdomen). Hernial defects can be single or multiple. Irrespective of its size, all hernias need to be addressed, and surgery is the treatment of choice.

Symptoms:

• Abdominal pain at the site of hernia or occasionally at another location due to a referred pain
• Swelling which may remain the same or gradually increasing in size
• Swelling which used to reduce suddenly becomes irreducible
• Nausea, vomiting, constipation, fevers
• Change in color of skin over the hernia, chest discomfort, dyspnoea on exertion, recurrent cough

Diagnosis:

• Ultrasound abdomen and pelvis
• CT abdomen and pelvis with contrast

Treatment:

• Surgery is the treatment of choice. Surgery involves reducing the contents to its normal anatomical location, closing the defect without tension, and reinforcing the defect area with mesh which gradually integrates itself into the muscles.
• In certain situations where the defect is very wide, mobilization of adjacent muscles (Transverse abdominis muscle release – TAR) may be required to achieve a tension-free repair.
• Hernias can be repaired both by Minimal invasive techniques, i.e Laparoscopic / Robotic and by Open technique.

Commonly Seen Hernias Include:

• Inguinal or groin hernias
• Umbilical hernia – At the umbilicus
• Epigastric hernia – Between the umbilicus and rib cage
• Incisional hernia – Those which arise from scars of previous surgery
• Para-stomal hernia – Hernias around the stoma
• Lumbar hernia – In the flank
• Femoral hernia – In the lower part of groin

Abdominal Wall Repair Techniques:

Factors Influencing Technique:

• Patient factors like age, comorbidities, body habitus, size of defect, contents
• Whether elective or emergency
• Is any other surgery/procedure planned along with hernia repair – Combined surgeries
• Whether the hernia repair is primary (First repair) or recurrent (Second or more)
• Hernia factors like location, size of defect, contents, number of defects
• Surgeon factors – Training and expertise