Hernia prevention and repair

Put simply a hernia is a “lump”, typically in the groin or belly-button.

A hernia occurs when there is

1. An opening or defect in the abdominal wall.
2. A sac bulging through this weakness (abdominal lining)
3. Contents of the sac may include fat or abdominal organs (bowel for example)

They can be present at birth, develop over time due to ageing of the body’s tissues, combined with stress or strain on the abdominal wall, or occur at the incision site from a previous surgery.

Are there different types of hernias?

There are four main types of hernias:

• An inguinal (groin) hernia: occurs when there is a protrusion through the lower abdominal wall (direct inguinal) or through the inguinal canal (indirect inguinal). It is more common in men than women.
• An incisional hernia: occurs through an incision (scar) from a previous abdominal surgery.
• An umbilical (ventral) hernia: occurs around the belly button. In infants, this is caused by an incomplete closure of the muscles around the umbilicus.
• A femoral hernia: occurs when there is a protrusion in the femoral canal, a passage at the top and front of the thigh. These are more common in women than in men.

What are the risk factors?

You are more likely to develop a hernia if you:

• are older, because tissues weaken as you age,
• suffer from chronic constipation or a chronic cough, as there is continued pressure on the abdominal wall,
• are pregnant,
• are overweight or obese,
• have a family history of hernias,
• carry or push heavy loads at work or sport, or
• are male, as men are eight times more likely to develop a hernia than women.

What treatment options are available for hernias?

Once a hernia has developed it will tend to enlarge, rather than shrink, over time. A truss or binder may temporarily relieve symptoms, but cannot cure the hernia. The risk of a hernia is that a loop of bowel will get caught in the hernia and become obstructed or have its blood supply cut off. This becomes a life-threatening situation.

Hernias can be repaired effectively and with minimal risk through surgery, so this is often recommended unless there are other serious medical problems.

During surgery a cut will be made to the abdominal wall to find the area of weakness. After the tissue is pushed back through the hole, the hernia will be pulled together with stiches. Often, a nylon mesh, patch or plug is also sewn in to strengthen the area and avoid reoccurrence. The skin and tissues that were cut to access the hernia are then stitched together to complete the repair.

Is surgery done via open or laparoscopic incision?

Either options are very effective. If you have an inguinal hernia on both sides, this can be repaired laparoscopically, that is via keyhole incisions that allows access to the defect from the inside of the abdominal cavity. Other types of hernias will normally be repaired via open surgery, with the size of the cut depending on the size of the hernia to be repaired.