A hernia is an abnormal protrusion of part of an organ through the tissues that normally contain it. A hernia can occur in almost any part of the body however abdominal hernias are most common. Depending on hernia site, size and type the hernia repair is repaired as either a laparoscopic (keyhole) or open incision. In most cases synthetic material (mesh) is used to repair and reinforce the abdominal wall defect as this provides the most durable result.
What disorders can occur?
Although there are many types of hernias, the following are the most common:
Epigastric or ventral hernia
These hernias occur due to a weak point or defect in the membrane (fascia) that connect the abdominal wall muscles together in the mid-line.
This hernia occurs in the groin due to protrusion either directly through a weakness in the lower abdominal wall (direct inguinal hernia) or by sliding down the inguinal canal with the cord structures that supply the testicle (indirect inguinal hernia). The latter type of hernia may reach the scrotum and if neglected over time can reach a significant size causing the scrotum to expand significantly.
This type of hernia occurs when a protrusion of abdominal contents extends into the canal containing the major blood vessels to and from the leg between the abdomen and the thigh (the femoral vessels).
This hernia occurs due to a weakness of the abdominal wall in the region of the navel.
An incisional hernia occurs after previous surgery where the abdominal wall or muscle layers had been divided and a weakness or defect persists allowing abdominal contents to protrude. This may occur due to problems with wound healing, infection or technical error with the previous surgery.
This occurs when part of the stomach full protrudes upward into the chest through the small opening in the diaphragm through which the esophagus (food pipe) passes from the chest into the abdomen.
Why do I need hernia surgery?
Small hernias that are not causing any symptoms may not warrant surgical repair. Hernias causing pain, limiting physical activity or of a significant size should undergo repair in an otherwise well patient. The most significant complication from a hernia can occur when bowel (intestine) protrudes into the hernia and occlusion of blood flow to the intestinal loop results (a strangulated hernia). This complication is considered a surgical emergency as tissue death (necrosis) of the intestinal loop will occur if blood flow is not restored by releasing the strangulated bowel. If the injury to the strangulated loop of intestine is too severe to be salvaged the intestinal loop would need to be excised.
What incision will I have?
The incision site and size will vary depending on the hernia type and whether the operation is being performed via a laparoscopic (key hole) or open approach.
What will the scar look like?
I close all skin incisions with buried absorbable sutures for an optimal cosmetic result.
With a laparoscopic (key hole) approach the incisions are only several millimetres in size and the resulting scar will often be virtually invisible once fully healed.
With the open approach the incision will be made in a natural skin crease near the site of the hernia (or through the previous surgical scar in the case of an incisional hernia). In most cases this will result in a discrete scar.
What complications can occur?
In most cases hernia repair is straightforward and can be performed as a day stay procedure. However as with any other surgical procedure complications can occur. Complications are uncommon and are variable depending on hernia type and size. These include infection, bleeding, cutaneous nerve injury, vascular injury, bowel injury and miscellaneous problems due to anaesthesia.
Complications directly attributable to synthetic mesh used for hernia repair are negligible provided the mesh is used correctly and by an experienced surgeon. Synthetic mesh hernia repair provides the most durable repair for any hernia of significant size. The long-term risk of hernia recurrence after successful repair is approximately 1-2%.
Will I need to be on Medications after my hernia surgery?
In most cases after a simple hernia repair analgesic requirement is minimal and generally not required beyond a few days after surgery. For larger or more complex hernia repairs there may be a greater requirement for analgesia but usually not required beyond the first couple of weeks after surgery.
How long will I be in hospital and expected recovery time?
In most cases a simple hernia repair will usually only require a same day admission. Patients with other significant medical conditions, elderly patients or for those requiring more complex hernia repairs will usually require at least an overnight hospital stay.