Hernia is the protrusion of abdominal contents (fat or intestines) through a weakness in the abdominal wall muscles, which present as a swelling over the abdominal wall. There are several types of hernia but the most common is the inguinal (groin) hernia. When a hernia occurs in another part of the abdominal wall other than the groin, it is called a ventral hernia. When a hernia is related to a previous surgical incisional scar, it is also called an incisional hernia.
Approximately 6% of all men will develop an inguinal hernia. Although a lot rarer in women, it is still the most common type of groin hernia in women. It can occur on either the right or the left side or less commonly, on both sides. Hernia can develop in all age groups: during childhood, in adults and in the elderly. Ventral and incisional hernias are less common compared to inguinal hernias. The most common type is the paraumbilical hernia where the weakness in the abdominal wall is just beside the belly button.
A hernia may become more apparent or bigger when the patient is standing or straining, and may disappear when lying down. It may be associated with discomfort, a pulling sensation, or even pain. If left untreated, a hernia may become larger and irreducible which can be further complicated by obstruction or strangulation of the bowel that is being trapped inside the hernia sac. This happens when the lumen of the bowel passing through the hernia opening (neck) becomes blocked or when the blood supply to the bowel inside the hernia is cut off by the tight narrowing at the hernia neck.
If a complicated hernia is left untreated, the patient will develop vomiting from bowel obstruction or severe pain in the hernia or abdomen from bowel strangulation. When such complications occur, the patient can become very ill and the condition may be potentially fatal.
Excessive strain on the abdominal muscle wall should be avoided.Do not lift or move heavy objects. Treat any underlying conditions (listed below) that result in straining. Drink enough liquids and eat foods high in fibre to avoid constipation. Exercise regularly and eat a healthy diet to maintain a healthy weight.
Patients with previous abdominal surgery can develop incisional hernia at the incision site. Ventral hernia can also occur in patients without previous surgery and some can be congenital (present at birth).
Weakness of the abdominal wall predisposes to the development of ventral hernia and is caused by conditions that put excessive strain on the wal:
Being overweight
Pregnancy
History of lifting / pushing heavy objects
Straining during urination or bowel movement
Lung disease such as chronic obstructive lung disease or emphysema (puts strain on abdominal muscle when straining to breathe and from persistent coughing)
Old age (weaker abdominal wall muscles as you grow older)
Your doctor may examine your abdomen and feel for bulges. During the physical exam, he may ask you to cough or bear down, which makes it easier for the ventral hernia to be felt.
Other imaging tests may be required for assessment, such as an abdominal ultrasound, abdominal CT scan, or an abdominal MRI scan.
If you suspect you have a hernia, or if you have an abdominal swelling, please see a doctor. Diagnosis is usually made by physical examination of the abdomen. For less obvious swelling, an ultrasound or a CT scan may help confirm the diagnosis. X-rays or a CT scan may also be performed to look for acute complications such as bowel obstruction or bowel strangulation. You may be advised surgery to prevent or treat the complications.
Surgery involves returning the abdominal contents to the abdominal cavity and reinforcing the weakened area of the abdominal wall. This is usually done with either suture repair and/or with a piece of mesh placed either under or over the weakened area. The mesh causes the body to form strong scar tissue in the region it is placed, hence strengthening the abdominal wall in that region.
The hernia repair surgery may be performed via an open approach by creating an incision over the length of the abdominal hernia, or via a laparoscopic (keyhole) approach where a camera and instruments are inserted through 5-10mm incisions into the abdominal cavity. Procedural time may vary depending on the size and complexity of your hernia. The details of hernia surgery will be discussed with you when you consult a surgeon.
Most simple hernia operations are performed as day surgery, and therefore you will probably go home on the same or following day that the operation is performed. More complex or recurrent hernia operations may require you to spend multiple days in the hospital after surgery.
Before surgery, you will be advised to lose weight, and treat underlying conditions that cause excessive straining (eg constipation, benign prostatic hypertrophy). This would help in reducing the risk of recurrence of the ventral hernia after surgery.
After surgery, light activities while resting at home after surgery is encouraged. Heavy lifting and physical exertion should be avoided. Most patients are able to resume normal daily activities in a short period of time.
There may be mild to moderate pain or discomfort at the operated area. You will be provided with pain medication.
Occasionally, a lump or swelling may develop in the area where the hernia had been. This is often due to fluid accumulating within the empty space, and is known as a seroma. With time, the majority will disappear on its own. If not, your surgeon may aspirate the fluid out in the clinic.
If you develop severe pain, fever, chills, vomiting or experience discharge from the surgical incisions, you should seek medical attention immediately.
You may resume light activities as soon as your doctor advises. When the wound is no longer painful, you may start doing light exercises including brisk walking, climbing stairs, jogging as well as cycling only escalating as your physical condition allows. You may be advised to refrain from lifting heavy loads over 10kg or doing strenuous exercises early in your recovery. An abdominal binder for supporting the abdomen may also be provided to you to wear during this period.
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