Hernia repair 

A hernia happens when there is a weakness or hole in a membrane, muscle sheet or other encapsulating structure in the body. Tissue can push through this area of weakness, causing swelling or pain. In some cases, the blood supply to the protruding tissue can be cut off if the hernia strangulates, so a hernia repair operation will be necessary.

The hernia is a bulge that is soft to the touch, and often gets bigger if you cough or strain when using the toilet. When you relax, or lie down, the hernia will usually become smaller. Hernias can happen at any age.

Hernia treatment

Once your GP has diagnosed a hernia they may refer you to a hospital consultant, depending on the size of the hernia and how it affects your day to day life. Surgery is not always necessary for hernia repair.

If necessary, hernia operations are most commonly performed under a general anaesthetic. In certain cases, however, doctors perform the operation using an epidural anaesthetic or even a local anaesthetic, which means that you will be conscious during the operation.

There will be some situations when the doctor thinks that surgery is not the best option for hernia treatment, usually because of other medical conditions. They may recommend that you wear a type of medical corset called a truss, which presses against the hernia to hold in the tissues.

The different hernia types

Inguinal hernias

Inguinal hernias are a commonest type of hernia ⁽¹⁾. The abdominal muscle sheet holds in the contents of the gut. Sometimes the muscle sheet will contain a weak spot which allows the internal membrane (peritoneum) and other tissues to bulge through.

The inguinal hernia can contain the peritoneum, fatty tissue and some of the bowel. If you have this type of hernia, the bulge will be located on one or both sides of your groin.

How big the inguinal hernia is relates directly to the size of the gap in the muscle wall of your abdomen. The larger it is the more your peritoneum and bowel can push through.

The longer you have a hernia, the bigger it will become and eventually this may cause you some discomfort - hernias can be quite painful. Some people may not feel any pain at all, however, but even so, a large hernia can make it difficult for you to live a normal life and do everyday tasks so it is advisable to seek hernia treatment in the early stages.

Femoral hernias

Femoral hernias are commoner in women than in men ⁽²⁾, especially overweight or obese women. It is called a femoral hernia because it is near the femur, which is the large bone from the hip to the knee.

A femoral hernia occurs when a section of bowel protrudes through the abdominal wall into the femoral canal that contains the main blood vessels and nerves going from the abdomen into the leg. These hernias are more prone to strangulation than other types, so need to be treated as soon as possible.

Umbilical hernia

An umbilical hernia happens near the belly button, where the umbilical cord was attached before you were born. It occurs when the muscles around the belly button fail to close up properly after birth. This can be quite common in babies, especially premature ones, but adults can have them too.

A baby's umbilical hernia will close up on its own in the majority of cases, usually by the time the child is four years old ⁽³⁾, so extensive hernia treatment will not be necessary.

Epigastric hernia

An epigastric hernia develops higher up the body, in the upper abdomen, causing a bulge between the breastbone and the navel.

Incisional hernia

An incisional hernia happens when internal tissues prolapse through an old wound created during surgery.

Hernia repair treatment

Open mesh repair surgery for inguinal hernia

In order to repair the inguinal hernia you may need to have open mesh surgery, where a cut is made in your groin.

The surgeon will then push the protruding fat and bowel through the hole back into your abdomen. The weakened area is then repaired with a special mesh and the skin is stitched or clipped closed and dressed.

Keyhole surgery for inguinal hernia

Hernia repair can be carried out by keyhole or laparoscopic surgery, where the surgeon makes smaller incisions, through which specially-designed instruments are inserted into the abdominal cavity to carry out the repair.

The surgical tool used is called a laparoscope, which is a very small, flexible instrument with a camera and light at the end of it. The camera sends a picture to a monitor, so the surgeon can see inside the body.

Two types of keyhole surgery exist:

• Transabdominal preperitoneal hernia repair (TAPP) passes through both the abdominal wall and the peritoneum to repair the weakened area.
• The Total Extraperitoneal Method (TEP) does not go through the peritoneum, but is a very new and less frequently used method.

According to the National Institute for Health and Clinical Excellence (NICE), TAPP or TEP hernia treatments must only be carried out by specially trained surgeons ⁽⁴⁾. You should ask your surgeon how many times they have performed the procedure and what their success rate is.

References:

1. Merck Manual | Abdominal Wall Hernias | Accessed May 21 2009 | Last full review/revision Sep 2007
2. Pharmaceutical Journal | Successful Truss Fitting | Accessed May 20 2009 | The Pharmaceutical Journal (Vol 268, p 62) | Jan 19 2002
3. Mayo Clinic | Umbilical Hernia | Accessed May 18 2009 | Last update Mar 22 2008 | DOI: DS00655
4. National Institute of Health and Clinical Excellence (NICE) | Hernia - laparoscopic surgery (review) | Accessed May 14 2009 | Guidance issued Sep 2004 | Guidance review date Sep 2010