If you have a localized bulge in the abdomen or groin region that sometimes comes with pain, chances are that you have a hernia. A hernia is a common condition and often produces no troubling symptoms. There are many types of hernia; however, the most common ones are inguinal hernia and femoral hernia. Hernia specialists can easily make a diagnosis by feeling and looking for a bulge. Depending upon the seriousness of the condition, the patients are generally asked to do watchful waiting or undergo corrective surgery. In this blog, we will learn more about hernias, their symptoms, when things get serious, and the latest treatments suggested by gastroenterologists in Dubai.
Hernia: What is it exactly?
A hernia occurs when the muscular wall that keeps abdominal organs in place weakens. The weak muscular wall allows organs and tissues to push through or herniate, leading to a visible bulge in the abdominal or groin region.
Generally, the bulge tends to disappear when the patient lies down. Other times it can be pushed back into the abdominal cavity. Any kind of stress or strain affecting the region, such as cough, can cause the bulge to get visible again.
In most cases, there are no obvious reasons for the formation of a hernia. Sometimes, a hernia can be congenital, meaning it is present at the time of birth in infants with failure of muscle development. At other times, children who have a weakness in their abdominal wall will develop a hernia over time.
Adults develop hernias due to strenuous activities (lifting heavy weights, physical exertion), medical conditions that cause chronic cough or general increase of the intra-abdominal pressure (cystic fibrosis, enlarged prostate, obesity, abdominal fluid, straining on passing stool or urinate, smoking, etc.). Weakness of tissues is another important factor, exacerbated by malnutrition, rapid loss of weight, etc.
People also may develop incisional hernias as a result of surgery. Women may also develop hernias as a result of pregnancy.
Do you have a hernia? Symptoms to look out for
A hernia may or may not cause discomfort at first. People generally notice a hernia as a bulge in their abdominal or groin region. Symptoms often start off when patients stand, strain, or lift heavy things. Increased swelling or soreness is also caused around the hernia following some physical exertion.
In some people, part of the gut becomes obstructed or strangulated by an inguinal hernia, requiring immediate medical attention. When this occurs, people experience pain, nausea, vomiting, and swelling around the hernia that cannot be pushed back into the abdomen. If the patient has a hiatal hernia, it can cause symptoms like acid reflux or heartburn as the acid from the stomach enters the esophagus.
Diagnosis and treatment
If you suffer from the symptoms of a hernia, it is important to visit your gastroenterologist or surgeon at the earliest. A simple physical examination is enough for your hernia specialist to identify and diagnose a hernia. An ultrasound or endoscopy procedure is recommended in case your doctor suspects complications such as bowel obstruction.
In infants, umbilical hernias tend to heal themselves within the first four years of their lives as the abdominal muscles strengthen. Inguinal hernia is the most common surgical condition in infants and children across the globe. If a child needs hernia repair, specialists may recommend a laparoscopic procedure or open procedure. A laparoscopic repair of a hernia has the advantage of a faster recovery and return to normal activities.
For adults, the standard treatment is conventional hernia-repair surgery or herniorrhaphy. A hernia can never resolve by itself, but it can only grow bigger. Also, there is the possibility of complications that require emergency surgery, such as incarceration and a strangulation. In case of an incarcerated hernia containing bowel, this will lead to bowel obstruction, and if the blood supply is compromised (strangulation), the bowel becomes ischemic with possibility of gangrene, intestinal perforation, shock and ultimately death if not treated.
The conventional treatment for a hernia is surgery. Depending upon individual circumstances and the location of the hernia, doctors recommend open surgery or a laparoscopic procedure.
Open surgery
The open surgical procedure focuses on closing the hernia with the help of sutures, mesh, or both. The surgical wound in the skin is then closed with sutures, surgical glue, or staples. Open surgeries are more often performed when the patient is at high risk for surgery, and in particular, in emergency cases.
Laparoscopic surgery
This is less invasive, with reduced surgical scars and chances of complications like infection. A hernia is repaired similarly to that of open surgery, but it is guided by a small camera and light introduced through a tube. Surgical instruments are inserted through another incision to complete the mesh/suture repair. The surgical wounds are minor with excellent cosmetic result.
Robotic surgery
Robotic hernia repair also relies on the use of a laparoscope and is performed in the same manner. However, here the surgeon sits at a console in the operating room and handles the surgical instruments from the console. The robot provides the surgeon with a 3-dimensional view of the inside of the abdomen as opposed to the 2-dimensional view of normal laparoscopic surgery, allowing him to easily sew meshes and stitches inside the abdomen. There is no advantage of robotic over laparoscopic surgery.
After hernia surgery, complete healing will take from three to six weeks (depending upon the procedure), and it is recommended not to lift more than 5 Kg for at least one month. For specific instructions, you must consult with your specialist.
Next steps
A hernia is a condition that doesn’t resolve with time in adults and may lead to complications. Therefore, the best solution is to undergo a surgical repair. Consult with Dr. Antonio Privitera, proctologist in Dubai and one of the pioneers of hernia mesh techniques to find the best treatment for your hernia.
