Hernia is the protrusion or projection of part of the intestine due to a weakening of the abdominal wall. It is easy for a patient to detect a hernia: when standing he may see a protuberance (bulge) in the affected area. Initially, the protuberance flattens and disappears when the patient lies down or presses the spot. Sometimes it is accompanied by discomfort, other times by pain that becomes more intense upon weight lifting, coughing or after standing for many hours. When the pain becomes severe, sharp and persistent, this might be caused by confinement, which must be immediately surgically treated to avoid intestinal ischemia and necrosis. In that case the patient must immediately contact his/her physician, because any delay may be fatal for his/her life. Hernias may be congenital, or may caused by a variety of factors, such as pressure on the abdominal walls caused by chronic cough, constipation, obesity, pregnancy, or manual work requiring frequent heavy lifting. They may also occur as a result of an injury or surgery.
Types of Hernias:
» Epigastric hernia
» Umbilical hernia
» Inguinal hernia
» Femoral hernia
» Sports hernia
» Incisional hernia
Their final management is surgical, since there are no conservative methods of treatment. The temporary use of a truss is only advised where surgery must be delayed, for risk of forming a scar tissue around the hernia, which renders later surgical treatment more difficult.
The ideal surgical approach for hernia repair is laparoscopy, during which a surgical mesh is placed over the damage, through 5mm incisions. The very small size of the incision eliminates the possibility of hemorrhage, severe postoperative pain and minimizes the patient’s stay in the hospital, which does not exceed 24 hours. Moreover, the laparoscopic repair has an advantage over the open surgical treatment of the hernia, due to the absence of postoperative inflammations and infections and because it reduces the probability of hernia recurrence to less than 1%.
Preoperatively, patients undergo simple cardiorespiratory and blood tests. If they are under anticoagulants or aspirin, they must stop taking them 5-7 days before the operation.
The operation is done by an epidural or by general anesthetic and the patient may return home as soon as he/she is able to walk, which in most cases is the same day. Return to normal daily activities is possible within a few days.
Postoperative pain is usually mild and treated with common analgesics. As previously mentioned, complications are rare, but if they occur they are easily treated conservatively, with medication. A patient must immediately contact his/her surgeon in case off hemorrhage, fever, severe abdominal swelling, nausea or vomiting. He/she will be re-examined 10-15 days after the operation.