INGUINAL (GROIN) HERNIAS

Inguinal hernias are very common (especially in men) and occur because of a defect in the inguinal canal – a tubular passage that runs between the layers of the abdominal wall in the groin. The defect allows abdominal tissue to push out.

The commonest sign of an inguinal hernia is a bulge or lump in the groin. Men may also have a lump and sometimes swelling in the scrotum.

The bulge or lump may be painful and the pain may worsen with activities like coughing, lifting, or standing. The lump may similarly become bigger and then become smaller with less pain when lying down. Many people report that their hernia gets worse towards the end of the day.

UMBILICAL (BELLY BUTTON) HERNIAS

Umbilical hernias are often seen in infants but may also develop in adults. They are characterised by bulging around the belly button. They may also be painful, get bigger with time and cause overlying skin to break down or get infected.

FEMORAL HERNIAS

A femoral hernia occurs in a similar location to a groin hernia but slightly lower near the top of the thigh- a small bulge is often seen.

Femoral hernias tend to occur more commonly in women and often feel worse with activity much like inguinal hernias. All femoral hernias require surgical treatment because they have a high risk of becoming strangulated (see above).

EPIGASTRIC HERNIAS

Epigastric hernias present as a bulge in the midline between the base of the breastbone and the belly button. Epigastric hernias can be small but may gradually grow larger and become painful. In the presence of symptoms, surgery is recommended.

SPIGELIAN HERNIA
This is a comparatively rare type of hernia which forms at the junction of the abdominal muscles ‘the abs’ and the oblique muscles. These often cause significant pain and are at a high risk of getting obstructed and thus surgery is usually recommended. In most cases, this can be done laparoscopically.

(Note: Hiatus hernias are different and this information is not relevant to hiatus hernias)

Although there are known risk factors for hernias, it can be unclear sometimes why a hernia has developed. In many, there is a history of long term abdominal straining from:

• Constipation
• Difficulty passing urine
• Chronic coughing
• Heavy lifting

Pregnancy also increases pressure on the abdominal wall and can lead to hernias. Surgical scars are a site of weakness and are a common site for hernias to develop.

Not all hernias cause symptoms. Common symptoms include:

• A lump that can change in size (it may disappear when lying down and bulge when standing, lifting or coughing). This can sometimes be disfiguring or cause overlying skin change.
• Pain that can be a dull ache and may be worse with activity, or a sharp pain with coughing or sneezing

Occasionally hernias can become trapped (incarcerated) and the lump may become hard and quite painful. If bowel is trapped in a hernia this can cause a bowel obstruction with nausea and vomiting and abdominal swelling. The blood flow to the trapped bowel may become blocked. Trapped hernias require emergency surgery and you should go directly to your hospital emergency department. At Harbour Surgery Centre, your team is experienced in hernia repair and understand the urgency and care with which hernia repair needs to be conducted.

Hernias are usually diagnosed by clinical examination and a scan is often not required. Sometimes an ultrasound or CT scan is needed to confirm a hernia is present or to provide more information to plan surgery.

Not all hernias need to be treated right away, especially if they are small and not causing symptoms. If you fall into this category, rest assured, your surgeon at Harbour Surgery Centre may recommend leaving a hernia if it is not interfering with your life or in the presence of other, more pressing medical problems.

If on the other hand your hernia requires intervention, most hernias are repaired with surgery and this may be done with either open surgery or minimally invasive (laparoscopic/robotic) surgery. Your surgeon will advise you of the best treatment option for your hernia.

The concept of hernia repair is simple. It requires identifying the hernia defect, dissection to determine the size and width and location of the defect and either pushing the contents back in (reducing the hernia) or excising them if appropriate. At this point, if the tissue surrounding the hernia defect is of good quality and the defect is small, it can be closed with stitches alone. However, in most instances, the same factors that lead to people getting a hernia mean that closure with sutures alone may not provide a satisfactory outcome. This is when mesh can sometimes be required.

Mesh is used to reinforce tissue around hernia repairs. In almost all instances, when mesh is required , it is not in contact with intra-abdominal organs.

In broad terms, hernias can be repaired via a traditional open approach or via minimally invasive means (laparoscopic or robotic surgery). In both instances, the principles of surgery remain the same as mentioned above. Most people are able to recover quickly and experience significant improvement in their quality of life after the procedure. Your surgeon will discuss if the minimally invasive option is the right one for you.