Hernias: the basic information you should know

If you have a hernia occur, it can be a bit frightening, possibly painful, as well. To explain the essential information about different kinds of hernias and their treatment options, expert consultant general surgeon Mr Greg Wynn details what to expect.

What is a hernia?

A hernia is when contents pass through a containing structure into an abnormal position. When a hernia occurs in the abdominal activity, it is usually at a point of natural weakness where important blood vessels or organs pass into another body cavity from the abdominal wall. For example, when the oesophagus or stomach is forced back up through the diaphragm into the chest, a hiatus hernia occurs; when fat or bowel is forced through the weak spot next to the major blood vessels which travel to the leg, a femoral hernia occurs.

How are hernias treated?

Hernias can cause pain or discomfort, can look unsightly, and interfere with daily activities. The contents of a hernia can become trapped and require emergency treatment. Most hernias will at some stage require surgery to stop them getting worse. However, if a hernia is not causing significant symptoms and is not rapidly enlarging, then it is perfectly reasonable to employ a watch and wait policy to see how things progress. There are some hernias that do generally require surgical repair regardless, due to their risk of specific complications, such as femoral hernias that have a high rate of entrapment and strangulation. The risk of complications must always be balanced against offering surgery to a patient for the operation and anaesthetic reasons. Either a conservative approach with support appliances or an operation under local anaesthetic can be the best option for those who are very unfit.

The vast majority of patients are suitable for a laparoscopic or keyhole repair and this gives them a good chance of day-case surgery with minimal complications and a quick return to normal activities. Some larger hernias, particularly incisional hernias where the patient has had previous abdominal surgery, can be challenging and require an approach through the old scar.

Which hernias are most common?

Inguinal or groin hernias are very common and contribute to a significant reduction in quality of life, prevent people from working and left untreated have a significant complication rate. Surgical repair of an inguinal hernia is generally a very good operation with a low complication rate and high patient satisfaction.

Recurrence rates are less than 2 per cent and about one in 20 or 30 patients suffer some sort of discomfort in the groin that extends beyond three months – this is a nuisance but can be treated by pain specialists. Occasionally, men who have pre-existing prostate trouble can find it difficult to pass urine after their operation and every now and again someone will need a temporary bladder catheter inserted.

As other complications tend to be minor or very rare, patients can be expected to return to desk work within three days, and between a week to two weeks back to light duties if they have had keyhole surgery. Patients should avoid heavy lifting for four weeks.

What are the benefits of keyhole surgery?

A minimally invasive approach to hernia surgery, using tiny incisions, can be beneficial to the patient in a number of ways. It is generally much less painful and therefore encourages day-case surgery and a quicker return to normal activities. Wound infection rates are lower, and for groin repairs the incidence of chronic pain is reduced. For obese patients with impaired tissue healing (i.e. patients on immunosuppressive drugs, have diabetes, smoke, etc.), a keyhole repair can have advantages. If a patient has a bilateral inguinal (or groin) hernia, they likely have the greatest gain from keyhole surgery. This is because both sides can be treated at the same operation with very little increase in post-operative consequences.

Recently, I had a patient with large hernias in both groins in addition to a hernia at the navel. We were able to use the hernia at his belly button for one of the keyhole ports to access the groin hernias and repair them and then fix the third hernia after taking the port out at the end of the procedure. He was able to have day-case surgery to fix all three hernias in a single operation and was back playing golf four weeks afterwards. This case really highlighted how a keyhole approach can be better for the patient, more cost-effective, and also improve workflow when waiting lists are long.

If you are experiencing a hernia or would like more information, you can schedule a consultation with Mr Wynn on his Top Doctors profile.