What are hernias?
Hernias occur when a weakness develops in the abdominal (tummy) wall which allows the internal contents of the abdomen to bulge out. Most hernias are treated with surgery. This is usually very successful.
Different types of hernia exist and the commonest types are:
This is the most common type of hernia and is found in the groin. There is a natural weak point in the groin area where structures connecting to the testicle cross the abdominal wall. Women also have a weak area at this point but it is less pronounced hence inguinal hernias are commoner in men.
There are two main types: indirect hernias where the hernia sac tracks with the structures crossing through the abdominal wall and direct hernias where the weakness is in the back wall of the tunnel transiting through the abdominal wall.
These also occur in the groin but the defect is a little lower than the tunnel relating to inguinal hernias. They occur more commonly in women.
These occur relating to weakness caused by a previous incision, especially if the wound became infected.
Umbilical and para-umbilical hernias
These occur near to the belly button (umbilicus). Umbilical hernias can be present from birth but many of these will heal themselves.
Hernias near the umbilicus in adults are called para-umbilical hernias and will not heal up spontaneously.
Who develops hernias?
Hernias in adults may result from things that strain or stretch the abdominal wall such as persistent coughing, obesity, pregnancy, straining on the toilet or lifting heavy objects.
What are the symptoms of hernia?
The commonest symptoms are pain and noticing a lump. Hernias can cause discomfort on movement or on lifting objects. If intra-abdominal contents (bowel or fat) become trapped in a hernia pain may be severe and the hernial lump will feel hard and tender. The skin overlying it may look inflamed.
Why do they need treatment?
Treatment to repair hernias it is usually advised. This is because adult hernias will not heal themselves and will tend to get bigger. Hernias carry with them a risk of abdominal contents being trapped in the hernia (strangulation). Studies have shown hernias cause more problems if left untreated over time. Traditionally asymptomatic hernias were often left untreated but recent research following up these people suggests that it is better to operate early even if hernias are not causing symptoms.
How are hernias repaired?
A hernia can be treated by a small operation. Wearing a support (truss) was a method used in the past but is now not recommended.
Most hernias can be treated as day cases avoiding the need to stay in hospital overnight. Some can be treated with local anaesthetic and others require general anaesthesia.
Different hernias are repaired in different ways but all involve the same broad steps-dissecting the hernia sac free, getting the contents of the sac back in the abdomen, often removing the sac and then repairing the weakness in the abdominal wall often using a mesh patch. Your surgeon will be able to discuss the type of operation with you in more detail.
Inguinal hernia repair
This can be done as an ‘open’ operation or by a ‘keyhole’ or laparoscopic operation. The open operation involves a larger groin incision than the ‘keyhole’ operation. This means the recovery is quicker for the ‘keyhole ‘repair. In most other respects the operations have a similar outcome. Most surgeons would accept that the ‘keyhole’ approach is better if the patient has hernias in both groins (bilateral) or if the repair is for a recurrent hernia. New guidelines also suggest the approach may be better for all inguinal hernias in women. Most inguinal hernias are repaired using a mesh. A mesh is a thin bit of material placed over the weak area of the abdominal wall. This has been shown to lead to a more robust repair with less chance of the hernia coming back.
Femoral hernia repair
Similar to inguinal hernias repair can be performed as an open or ‘keyhole’ operation. The weakness in the abdominal wall is smaller than in an inguinal hernia and repair tends to be with a plug of mesh rather than a sheet of mesh if the operation is open.
Incisional hernia repair
Incisional hernias vary enormously in size, which means that treatment may differ depending on the size of the incisional hernia. Again, a mesh is usually used, especially for larger hernias.
Umbilical and para-umbilical hernia repair
If the hole in the abdominal wall is small these hernias are often repaired with stitches alone. Larger defects are repaired with mesh to reduce the chance of recurrence. Surgery can be performed as a ‘keyhole’ operation but the benefits are not as marked as for inguinal hernias.
Unfortunately, hernia repairs are no longer automatically funded on the NHS.
However, Exeter Medical’s consultants are happy to see patients who have a hernia and would like to consider having it repaired. This can be performed in Exeter Medical’s own operating theatre at a competitive cost to self-pay patients.
Where more extensive surgery is required there would be the option of having surgery as a private patient either at the Royal Devon and Exeter Hospital or at Nuffield Health Exeter.