When hernia bothers you

A hernia is a defect (hole) in the abdominal muscles through which the abdominal contents (usually fat but sometimes intestines or other abdominal structures) can protrude. That can occur on one or both sides (bilateral) of the groin. It is more common in male.

Hernias may be present at birth, or develop in later life as a result of any factor that weakens the tissues of the abdominal wall (e.g., inherited, genetics, increasing age, smoking, increased pressure within the abdomen - long term cough and sustained heavy lifting).

Hernias may simply present as a painless bulge that enlarges with standing or coughing. Commonly though they cause an aching discomfort or a dragging sensation, occasionally a piece of bowel or fat can get stuck and twisted within the hernia. This is very painful and can lead to a strangulated hernia which is a life-threatening emergency. It is generally recommended, therefore, that hernias be repaired to prevent such complications arising.

Most groin hernias are diagnosed by the clinical history and examination alone. Occasionally, if the diagnosis is unclear or if pain is the predominant symptom and there is no obvious swelling further investigations may be used.

Although having a hernia is not usually a serious condition, hernias will not go away without surgical repair. There is a small chance that a hernia may lead to bowel obstruction or strangulation. A loop of intestine becoming trapped and strangulated.

The surgical options include:

a. Open surgery: A small incision is made in the skin (usually 2.5 – 3 inch) in the groin area.

b. Keyhole or laparoscopic, surgery: Your operation will be carried out under general anaesthetic. One 10 mm and two 5 mm cuts are made in your abdomen.

In a procedure called TAPP (Trans-Abdominal Pre-Peritoneal), the telescope is placed into the abdominal cavity. In another procedure called TEP (Totally extra-peritoneal), the abdominal cavity is not entered and the operation takes place placed in the space between the muscles and the lining of the abdomen. All of the operations usually take between 30 minutes to 90 minutes operating time.

Many patients, who develop a hernia, have a tissue weakness'which does not hold stitches well. This explains why repairs with stitches have a higher failure rate than those with additional mesh. For the vast majority of patients, mesh poses little if any additional risk, and coupled with a lower recurrence rate, has resulted in the use of mesh becoming the gold standard in hernia repairs.

The surgeon's expertises in a particular technique are at least as important as the type of repair that is being performed. Take your decision after discussion with your surgeon.

In certain circumstances keyhole laparoscopic repair may be beneficial. These are:

·        recurrent hernias (that have come back after being surgically repaired before using the open operation).

• bilateral hernias (hernias in both groins)

• hernias in women (there is some evidence that women have a higher chance of another undiagnosed hernia that is not easily seen during open surgery)

• very active patients whose predominant symptom is pain

If you experience any of the symptoms below you should contact your surgeon as soon as possible and it is important, to make them aware of this.

• Severe  abdominal groin or testicle pain

• Loss of appetite, increasing nausea or vomiting

• Fever or flu like symptoms

• Redness/swelling at the surgical site

• Calf pain or increasing breathlessness

Usually you can go home on the same day. Sometimes it is recommended that you stay in overnight. You should be able to return to office work by two weeks and manual work by about four weeks.

Dr Mohammad Abdullah Al Mamun is a Consultant, Laparoscopic Surgeon at Square Hospitals, Dhaka. E-mail: mamun1973@gmail.com