How important is it to treat a hernia?

A protruding lump caused by tissue and organs pushing through the muscle wall, might be a hernia. Affecting people of all ages, hernias can develop into dangerous conditions if they are not managed correctly.

Mr Krishna Moorthy, highly esteemed surgeon, provides a comprehensive overview of hernias, explaining what are the causes, how important is it to treat a hernia and what are the side effects of hernia surgery.

What are hernias?

Hernias occur when a defect in the muscle of the abdomen through which structures inside it (including fat), protrudes.

Appearing spontaneously, hernias can develop anywhere in the abdomen and the groin, either in the middle of the abdomen, around the belly button (umbilicus hernia) or in the groin (inguinal and femoral hernias), depending on their locations.

Other types of hernias are incisional hernias, which appear after open surgery along a scar following previous surgery, and hiatus hernia, in which the stomach bulges through the diaphragm into the chest. A hiatus hernia is considered an internal hernia.

What are the causes of hernias?

Hernias occur more often in people who are athletic, people who lift weights, people whose job involves standing for long periods of time, people who strain at stools or when passing urine and people who have a chronic cough.

With straining, a hernia develops in a weakness in the muscles of the abdomen after the straining force slowly causes the pressure in the abdomen to increase.

However, hernias often have no cause.

What are the symptoms?

You may have a hernia if you have a swelling in the groin or the abdomen which often changes in size with activity.

Pain and discomfort are other symptoms of hernias, which are the result of pressure on nearby nerves. These symptoms also usually appear at the end of a day after prolonged sitting or walking periods.

Some types of hernias, such as hiatus hernias, can cause more specific symptoms, including heartburn (acid reflux). Also presenting as groin pain, groin hernias may present without an obvious swelling, especially when performing physical activities.

Hernias can even lead to gangrene of the bowel (strangulation) caused by a bowel getting caught in a hernia, leading to bowel blockage. This is referred to as an obstructed hernia and is a dangerous condition to have.

How important is it to treat a hernia?

There is a high chance that a hernia will grow in size and cause symptoms in time, if it is not treated.

Treatment for hernias is needed due to the likelihood that they could become extremely painful and possibly difficult to reduce even with intervention. This condition is called an irreducible hernia. An irreducible hernia that involves the bowel, resulting in bowel blockage, is called an obstructed hernia. This is a dangerous condition which, if left unoperated for a long time, can result in the bowel losing its blood supply, a condition known as a strangulated hernia.

The size of the muscle defect and the conditions that lead to the hernia, like a chronic cough, will affect the occurrence of these complications.

What is the treatment for a hernia?

A hernia will never go away on its own and are usually treated by surgery. This is the only way of curing a hernia, given that the long-term use of a truss (a belt with a soft sponge that plugs the muscle defect) that prevents the contents of the abdomen from bulging from the defect, can increase the risk of suffering complications. After understanding the risk of developing complications, a truss should only be used with a surgeon’s advice.

Surgery for asymptomatic hernia is still open to debate, but research suggests that they should probably be operated earlier rather than later. In research studies, patients with asymptomatic groin hernias were split into those who underwent surgery and those who were kept under observation (‘watch and wait’). Results revealed that half of the patients in the second group had to undergo hernia surgery two to three years later, after their hernias started causing symptoms. This concluded that a hernia will grow and cause discomfort in the future if it is present, despite not causing symptoms. Patients should be counselled about this and allowed to make a decision as to whether they want to have surgery or wait.

For patients with hernias that are causing pain and discomfort, surgery is usually advised. This can either be performed with open or keyhole (laparoscopic) techniques.

In an open hernia repair, a surgeon makes an incision at the site of the hernia and reduces the hernia. The hernia defect is then closed with a mesh (a piece of synthetic material) that is introduced and fixed through the skin incision, with the use of sutures.

In a laparoscopic hernia repair, a surgeon makes small cuts (half a centimetre to a centimetre long) through which three instruments, to perform the surgery, are introduced. The surgeon reduces the hernia from within the abdomen and then closes the hernia defect with a mesh that is introduced and fixed into place in the abdomen with dissolvable synthetic staples.

Which repair to use (open or keyhole) depends on the type of hernia, the presence of one or multiple hernias, the patient’s fitness for general anaesthesia and the consultation between the patient and the surgeon.

While both types of repairs have a similar success rate and hernia recurrence, there are differences in terms of post-operative recovery. Open repair with local anaesthesia is preferred for simple groin and abdominal wall hernias. For more complex incisional hernias, the number of hernias and the size of the hernia defect will determine whether to choose open or laparoscopic surgery.

The pre-operative consultation between the patient and the surgeon will discuss if there is a need for surgery, the type of surgery to have (open or laparoscopic), the type of anaesthesia (local, regional or general) and the possible complications.

Are there any side effects to hernia surgery?

The risk of developing major complications, including infections, is rare.

Pain is usually short-lived, but it can last for months to even years after hernia surgery. However, this only occurs in rare cases (less than 5 per cent) and it is usually caused by a result of injury to small nerves during the operation.

More common with very large hernias, hernia surgery can lead to the development of swelling at the site of the hernia from blood (called haematoma) or from body fluid (called seroma).

There is also a very small risk of recurrence (relapse) after hernia surgery. The use of the mesh lowers this risk even more, to less than one per cent for simple hernias and only slightly higher in more complex incisional hernias.

Some exceedingly rare complications include testicular pain and damage to the blood supply. With one to two in 1,000 cases, damage to the bowel during laparoscopic surgery is also extremely rare.

Mr Krishna Moorthy is a highly esteemed London-based surgeon with specialist expertise in hernia surgery and upper gastrointestinal surgery. If you have symptoms of a hernia and wish to seek expert treatment, don’t hesitate to visit Mr Moorthy’s Top Doctors profile today.