Understanding hernia surgery, prevention, and risks

In the second part of a two-part series, Mr Vanash Patel continues his discussion on hernias. He talks about the various surgical techniques, the advantages and potential risks associated with each method, if there’s any precautions or changes in lifestyle you can make to prevent the condition worsening or reoccurring and what are the complications with poorly treated hernias.

Could you explain the various surgical techniques used for hernia repair, including both open and laparoscopic approaches? What are the advantages and potential risks associated with each method?

Hernia repair surgery can be performed using different techniques, each with its own set of advantages and potential risks. The two main approaches are open surgery and laparoscopic (minimally invasive) surgery. The choice of technique depends on factors such as the type and size of the hernia, the patient's overall health, and the surgeon's expertise. Here's an overview of both approaches:

Open hernia repair:

1. Tension repair (Bassini, Shouldice): Involves suturing the edges of the hernia defect together. This method has become less common due to a higher risk of recurrence and discomfort.

2. Tension-free repair (Lichtenstein, Prolene Hernia System):

• Utilises a synthetic mesh to reinforce the weakened abdominal wall.

• Typically performed under local or general anaesthesia.

• Advantages: Lower recurrence rates compared to tension repairs.

• Risks: Risk of mesh-related complications, infection, and pain at the mesh site.

Laparoscopic hernia repair:

 1. Transabdominal preperitoneal (TAPP)

• Repair: Involves creating a space between the abdominal wall and the peritoneum (inner lining of the abdomen) to place a mesh.
• Performed using a laparoscope and small incisions.
• Advantages: Less postoperative pain, quicker recovery, smaller incisions, and potential for bilateral (both sides) repair in inguinal hernias.
• Risks: Potential for injury to abdominal structures, risk of hernia recurrence, and mesh-related complications.

2. Totally extraperitoneal (TEP)

• Repair:  Similar to TAPP but involves placing the mesh outside the peritoneum.
• Advantages and risks are similar to TAPP.

Advantages of laparoscopic repair:

• Smaller incisions: Reduced scarring and less postoperative pain.
• Faster recovery: shorter hospital stays and quicker return to normal activities.
• Potential for bilateral repair in inguinal hernias: Both sides can be addressed simultaneously.
• Less risk of wound complications: Lower risk of infections and wound-related issues.

Potential risks of laparoscopic repair:

• Risk of injury to abdominal structures (blood vessels, nerves, intestines) during trocar insertion.
• Risk of hernia recurrence.
• Mesh-related complications, such as mesh migration, mesh shrinkage, or adhesion formation.
• Longer operating time and potential for longer learning curve for surgeons new to laparoscopic techniques.

It's important to note that the choice between open and laparoscopic repair should be based on a thorough assessment by a surgeon who can tailor the approach to the patient's specific condition and needs. The risks and benefits of each technique should be discussed with the patient to make an informed decision. Additionally, advances in surgical techniques and materials continue to evolve, potentially influencing the approach used for hernia repair.

Are there any specific precautions or lifestyle modifications that individuals with a hernia should consider to prevent the condition from worsening or recurring? How important are weight management and physical activity in managing hernias?

While hernia repair surgery is often necessary to address the underlying issue, there are several precautions, lifestyle modifications, and habits that individuals with hernias can consider to manage their condition and reduce the risk of worsening or recurrence. Here are some important points to keep in mind: 

1. Weight management: Maintaining a healthy weight is crucial for managing hernias. Excess weight puts additional strain on the abdominal wall, potentially exacerbating the hernia. Weight loss through a balanced diet and regular exercise can reduce this strain and improve overall abdominal strength.
2. Proper lifting technique: Individuals with hernias, especially those involving the abdominal region, should be cautious when lifting heavy objects. Using proper lifting techniques (bending at the knees, not the waist) can help minimise the strain on the abdominal muscles and the hernia site.
3. Avoid straining and heavy lifting: Straining during bowel movements, urination, or lifting heavy objects can increase pressure on the hernia, potentially causing it to worsen or become more symptomatic. Avoid activities that involve excessive straining.
4. Diet and fibre intake: Consuming a diet rich in fibre can help prevent constipation and reduce the strain during bowel movements. Adequate fibre intake can promote regular and comfortable bowel movements, reducing the risk of exacerbating hernia symptoms.
5. Physical activity: Engaging in regular physical activity can strengthen the abdominal muscles and improve overall core strength. Low-impact exercises such as walking, swimming, and gentle yoga can be particularly beneficial. However, individuals should consult their healthcare provider before starting a new exercise regimen.
6. Smoking cessation: Smoking can impair the body's ability to heal and increase the risk of complications after surgery. If surgery is necessary for hernia repair, quitting smoking can improve surgical outcomes.
7. Posture awareness: Maintaining good posture can reduce strain on the abdominal muscles and help prevent the hernia from worsening. Focus on keeping the core engaged and avoiding positions that put undue pressure on the hernia site.
8. Medication management: If you have a hiatal hernia or experience acid reflux symptoms, managing your diet and avoiding triggering foods can help reduce symptoms. Over-the-counter antacids or prescription medications prescribed by a healthcare provider can provide relief.
9. Regular check-ups: Regular follow-up appointments with your healthcare provider are essential to monitor the hernia's progress and address any concerns or changes in symptoms.

It's important to note that while these lifestyle modifications can help manage hernias, they may not cure the condition. Surgical repair is often necessary for significant or symptomatic hernias. Consulting with a healthcare provider is crucial to determine the appropriate course of action based on the individual's condition and needs.

What are the potential complications associated with untreated or poorly managed hernias? Are there any red flag symptoms or signs that may indicate a hernia-related emergency, requiring immediate medical intervention?

Untreated or poorly managed hernias can lead to a range of complications, some of which can be serious and require immediate medical intervention. It's important to be aware of potential complications and be vigilant for any red flag symptoms that could indicate a hernia-related emergency. Here are some potential complications and signs to watch out for:

1. Incarceration: An incarcerated hernia occurs when the herniated tissue becomes trapped and cannot be pushed back into its normal position. This can cause pain, swelling, and tenderness at the hernia site. In some cases, an incarcerated hernia can lead to bowel obstruction, where the intestine becomes blocked, causing severe pain, nausea, vomiting, and an inability to pass gas or stool.

2. Strangulation: Strangulation occurs when the blood supply to the herniated tissue is compromised, leading to tissue death (necrosis). This is a medical emergency. Symptoms include severe pain, rapid worsening of swelling and tenderness, redness or discoloration of the hernia site, fever, and signs of infection. Strangulated hernias require immediate surgical intervention to prevent tissue death and potential complications.

3. Peritonitis: If a strangulated hernia leads to perforation or rupture of the intestine, it can result in peritonitis, which is inflammation and infection of the peritoneal cavity (the abdominal cavity that holds the organs). Symptoms include severe abdominal pain, fever, abdominal distension, nausea, vomiting, and altered mental status. Peritonitis is a medical emergency and requires prompt medical attention.

4. Obstruction: In some cases, hernias can cause partial or complete bowel obstruction, leading to symptoms such as abdominal pain, bloating, vomiting, and inability to pass gas or stool.

5. Chronic pain and discomfort: If a hernia is left untreated or not properly managed, it can lead to chronic pain and discomfort, affecting the individual's quality of life and daily activities.

Red flag symptoms that may indicate a hernia-related emergency requiring immediate medical intervention include:

• Sudden and severe abdominal pain.
• Nausea and vomiting.
• Inability to pass gas or have a bowel movement.
• Redness, warmth, or discoloration at the hernia site.
• Severe swelling, tenderness, or rapid changes in the size of the hernia.
• Fever, chills, or signs of infection.

Mr Vanash Patel is a distinguished consultant colorectal and general surgeon with over 20 years of experience. You can schedule an appointment with Mr Patel on his Top Doctors profile.