What is a Hernia?
A hernia is a hole in the muscle of the abdominal wall allowing the contents of the abdomen to push through. This may appear as a lump or swelling which may be painful or uncomfortable. It may bulge out when coughing or straining and may be pushed back into place with gentle pressure.
Hernias are named according to the area of the abdomen affected.
Types of Hernias
- Inguinal
- Femoral
- Incisional
- Paraumbilical
- Spigelian
- Inguinal hernia
Causes
Anything that increases the pressure in your tummy can make you more likely to get an abdominal hernia. This includes:
- coughing resulting from chronic chest disease
- straining due to constipation
- lifting heavy weights
- overweight
- pregnancy with twins/large babies
Presentation
Inguinal hernia
Inguinal hernias are the commonest type of hernia and common in men. They usually present as an intermittent swelling in the groin and may cause pain or discomfort. It occurs when a weakness develops through the groin tunnel alongside the blood vessels that go and come back from the testicle (this tunnel through the muscle to the testicle is called the inguinal canal.
Femoral hernia
These hernias also develop in the groin but are usually a little lower and more commonly seen in women. They usually present as a swelling in the groin causing discomfort but may be painless. They may also present as an emergency with severe pain/vomiting due to strangulation involving and trapping bowel.
Incisional hernia
Incisional hernias may result from breakdown/weakness at the site of a previous abdominal operation anywhere in the abdominal wall. A bulge appears under an old surgical scar. and may contain contents from inside the abdomen. An incisional hernia may develop at any time following abdominal surgery sometimes several years after surgery.
Umbilical & Paraumbilical hernia
Both these type of hernias occur at the tummy button. Usually, umbilical hernias occur in babies and very young children with paraumbilical hernias developing later in life as an adult and commonly associated with being overweight in patients with poor musculature. A bulge appears in or around your belly button. Umbilical hernias are very common in babies but often disappear by the time the children reach 5 years. In adults. Paraumbilical hernias are by far the most common, being common in women and may require surgery.
Investigations
Usually most hernias don’t require further investigations as the history and careful abdominal examination is sufficient to make a diagnosis and management plan. Examination in the standing position is important to confirm the diagnosis. At times ultrasound examination is necessary and helpful to clarify the diagnosis. Rarely, a CT or MRI scan may be performed.
Hernia Treatments
Patients with a hernia require individual assessment to have a bespoke treatment plan. Some patients may not require surgery and can be treated conservatively. Others may require a procedure under local anaesthesia and those fit for general anaesthesia would be suitable for general anaesthetic with keyhole (laparoscopic) procedure as a good option. Patients are advised to undergo surgery if the hernia causes pain or if there is a significant risk of bowel strangulation.
Hernias may be repaired by either open surgery or laparoscopic (keyhole) surgery. The hole or defect in the abdominal muscle wall is blocked off using a surgical mesh with good overlap staying in place permanently. Laparoscopic surgery has the advantage of using 3 small cuts resulting in a quicker recovery.
Inguinal hernia Repair
Open
Open surgery does require a larger incision (usually 8cm) but has the advantage of being able to be performed under a local anaesthetic if a general anaesthetic is thought to be more risky. The recovery time is a little more prolonged and is associated with an increase in early post operative and long term neuralgic pain and numbness compared to laparoscopic repair.
Keyhole -Laparoscopic
Keyhole (TEP – Totally Extra-Peritoneal) inguinal repair always requires a general anaesthetic with muscle relaxation but has the advantage of less post operative pain, a quicker recovery and less neuralgic nerve pain.
Incisional hernia
Laparoscopic Repair
Incisional hernias following previous major abdominal surgery may be repaired either by open techniques or keyhole (laparoscopic) surgery. Open surgery usually involves fairly major surgery using an epidural for pain relief with stays in hospital for several days. The advantage of a laparoscopic repair is that it is less painful, doesn’t require an epidural and the procedure may be performed usually as an overnight stay.
Expectation of Treatment
Keyhole(TEP) or open inguinal hernia repair
A long acting local anaesthetic is placed in the wounds at the end of the operation to help with post operative pain relief and three small dressings will be placed over the three small cuts – one on the tummy button and two just below this in the lower part of the tummy. It is common for the tummy button dressing is changed after the operation by the nurse on the ward before going home as the dressing becomes soaked with a small amount of the local anaesthetic/blood which seeps out through the tummy button cut.
It is usual to have some mild discomfort in the lower abdomen on the side of the hernia for a few days but this discomfort can be minimised by using 1G paracetamol (2 tabs) four times per day for the first 3 days. In addition, either codeine or ibuprofen (if not contraindicated) may be taken if the regular paracetamol is not sufficient.
If the hernia was relatively large and starting to descend into the scrotum, 24-48hr following the operation, you will develop swelling and bruising of the private area including the scotum and penis. The bruising may last for 7-10 days and the swelling may last longer, then slowly settle.
Postoperative advice
Ever patient is different and recovery depends on a number of factors including age, fitness and precise procedure. You are encouraged to be active and attempt to build up the ‘amount’ of activity e.g. walking over the first few days.
You may shower on the day after surgery as the dressings applied are waterproof and don’t need to be kept dry. When the dressing is remove, it is not imperative to keep the wound dry but advisable to dry the area with a clean personal towel.
You should avoid any heavy work/lifting for the first 4-6 weeks to allow the repair to strengthen. You are advised to Incrementally increase the intensity of your activity during this period but to gauge this depending on any reaction to the activity. The area continues to strengthen for a period of 2- 3 months and may cause occasional twinges/discomfort if you do too much.
Follow up
Dressings may be removed 4 days following the procedure by the patient if happy to do so but if you prefer, it can be arranged for nursing staff at the Nuffield or GP’s surgery if you prefer.
Arrangements will be made for you to be seen in the clinic at 2 weeks for review by Mr Poskitt.
Contact Information
If you have any questions please contact Mr Poskitt’s Secretary, Simone Avery:
Phone: 01242 235861
Mobile: 07946 679968
Cheltenham Nuffield: 01242 246500