Written by Catherine Meyers for Doctify
Hernia, we have all heard of the condition before. It’s been mentioned here and there in our daily lives, but do we really know what it is? We asked Mr. Khaled Dawas, a specialist Upper GI Surgeon with many years’ experience of treating simple, complex and hiatus hernias all about them.
What is a hernia?
A Hernia is a weakness in a muscle, which allows a bulge to appear. This bulge usually contains a layer of fatty tissue, called omentum, and occasionally bowel.
Where do hernias appear?
Groin hernias: The most common hernias are in the groin region. These are called “Inguinal” or “femoral” hernias. Inguinal hernias appear just above the line separating the thigh from the abdomen (the groin crease) and usually starts with occasional bulging on straining. It can be pushed back or it drops back on its own when lying flat and relaxed. A femoral hernia appears in the groin crease.
Incisional hernia: A hernia at the site of a previous operation in the abdomen is called an “incisional” hernia. It is usually a result of weakening of the muscle healing at the site of the previous surgery.
Hiatus hernia: Other hernias may be invisible, such as a hiatus hernia. This hernia results from the stomach pushing through a weakness in the muscle between the chest and abdomen, the diaphragm.
What are the symptoms of a hernia?
Groin hernias are more common in men and happen at any age
though they occur more frequently at an older age. Most of the time groin and incisional hernias are only noticeable as a lump and may not have any other symptoms. They can also cause pain when they bulge. Hiatus hernias can produce increasing indigestion and if they are very large they can interfere with swallowing and even cause shortness of breath.
How is a hernia diagnosed?
Most hernias are diagnosed by taking a careful history and examination of your abdomen and groin. Occasionally a scan may be needed for confirmation if the examination is inconclusive. Hiatus hernias require an endoscopy, a CT scan and occasionally a barium swallow.
Are hernias dangerous?
Hernias are very common and only a small proportion are a danger to your health. If the lump becomes stuck and painful you must seek urgent medical attention. This may be a sign of the bowel getting stuck in the muscle defect and can result in the bowel losing its blood supply. If you have a large hiatus hernia and it becomes stuck you will find extreme difficulty swallowing, profuse vomiting and feel particularly unwell. You should also seek urgent medical attention in this case.
What is a complex hernia?
You may read about so-called complex hernias. This describes large, recurrent or hernias in patients who have complex medical problems. Hiatus hernias are also complex and specialist surgeons with advanced Upper GI Surgery skills should only perform these on.
What is the treatment for hernias?
Most groin and incisional hernias are repaired using a Mesh. This is a synthetic, plastic type material which helps reduce the chance of recurrence. The mesh can be placed via open or keyhole (laparoscopic surgery) surgery. There are merits and drawbacks to each approach and your surgeon should be able to talk you through what is the most appropriate technique. Not all hernias are best repaired with laparoscopy and your surgeon should take into account the size of the hernia, previous surgery, the location of the hernia and your background health status. Groin hernias are usually performed on a day case basis. Hiatus hernias are usually repaired laparoscopically.
What happens after surgery?
After groin surgery, you will need to take a week off work and avoid heavy lifting and exercise for 4 to 6 weeks. You will have some pain for about 2 to 3 weeks and will need to take regular painkillers for at least 5 days. After incisional hernia surgery you may need to be in hospital for a few days depending on the size of the hernia and type of repair performed. Again your surgeon will advise you on the duration you should avoid heavy lifting for.
Hiatus hernia surgery normally includes an overnight stay after surgery. You will be advised on your dietary restrictions as this includes a variable period over some weeks of eating pureed food only.
With all this being said, if you are unsure about your symptoms or are experiencing some pain seek a specialist’s help as soon a possible.
