What are Hernias？
Hernias occur when there is a gap in the abdominal muscle layer, allowing internal organs (usually the small intestine) to protrude. In most cases, because it’s a structural disease, hernias do not heal on their own and cannot be treated with medication; surgery is the only definitive solution. The protruding organ is most commonly the small intestine. If not treated, the hernia can grow larger, and if the protruding organ becomes "strangled," it can block the intestine and affect its blood supply, potentially leading to severe complications such as bowel obstruction or intestinal necrosis/ gangrene. This is call strangulated hernia.
There are many types of hernia, depend on its location, like umbilical hernia, inguinal hernia, femoral hernia, diaphragmatic hernia. The commonest type is inguinal hernia.
Inguinal hernia - Symptoms
- A hemispherical lump appears in the lower abdomen or inner thigh
- Pain occurs when coughing, standing, or straining, and the lump retracts when lying flat, and the symptoms subside
- Severe abdominal pain, vomiting, or fever in case of strangulation
Causes and High-Risk Groups
Main Causes: Weakness of the abdominal wall muscles (surgical scars, ageing and prostatic disease in male etc.)
Triggers:
- Prolonged increase in abdominal pressure (such as constipation, coughing, lifting heavy object)
- Pregnant women (increased abdominal pressure from the growing fetus)
- There is a higher incidence of inguinal hernia in males because in males the spermatic cords and their blood vessels run through the inguinal canal to the testis in the scrotum
Diagnosis Methods
- Most cases of the inguinal hernia can be detected by clinical examination alone
- Concealed hernias (such as femoral hernias) may require ultrasound, MRI or CT scans for assistance
Treatment
Surgeries can be divided into two types:
- Minimally Invasive Hernia Repair
The doctor only needs to make three small incisions in the patient's abdomen (about 0.5 to 1.0 cm size) and then insert slender surgical instruments. Using the same three wounds, both left and right side groin hernias can be operated on during the same operation session. The operation involves reducing the hernia and using synthetic mesh to occlude the abdominal wall defect. Because the incisions are small, this approach lowers the risk of infection and minimizes postoperative pain, allowing patients to be discharged on the same day. The doctor may also inspect other parts of the abdominal cavity with the endoscope to rule out early hernias in other areas. This type of operation requires very light general anaesthesia. - Open Surgical Method
Open groin hernia repair can be done under local anesthesia, regional anesthesia, or general anesthesia. The traditional method of suturing the muscle gap with stitches has a higher recurrence rate. Nowadays, most hernia surgeries utilize synthetic mesh to occlude the hernia defect and reinforce the muscle layers, which remains permanently in the body.
The main materials used for these meshes include polypropylene or polyester. These materials have been in use for decades and are considered to have a high safety profile.
Open groin hernia surgery addresses only the hernia on the operative side. The surgeon is unable to examine the surrounding groin area or the contralateral side for potential concurrent hernias. Also, the surgeon cannot repair the other groin hernia using the same wound.
