A hernia is a condition where internal organs in the abdominal cavity move through an abnormal passage to another location.
These organs include the bowels and omentum which is a fat apron of tissue that hangs covering the internal organs. It can occur anywhere from the diaphragm down to the groin.
Patients often feel a lump in the affected area and if left untreated, there is a risk that the displaced organ may become trapped in the passage leading to a condition known as incarcerated hernia. This complication may cause bowel obstruction or strangulation requiring emergency surgical intervention.
Dr.Nattaporn Nuanuthai, our general surgeon at Bangkok Hospital Hua Hin shares that hernias can occur in individuals of all genders and ages, but they are more commonly found in males than females.
In children, hernias often develop from birth and are associated with a natural opening that closes later than usual. In contrast, adults frequently experience hernias later in life, with risk factors such as increased abdominal pressure due to chronic coughing from lung disease, regular heavy lifting, strenuous physical activity, constipation, or enlarged prostate.
Hernias come in various types depending on their location, including: 1) Inguinal Hernias: which occur in the groin area and commonly found in males.
2) Umbilical Hernias: which is located around the belly button.
3) Incisional Hernias: which develop in individuals who have previously undergone abdominal surgery.
4) Ventral Hernias: which have various names based on their locations, such as Spigelian Hernia or Epigastric Hernia.
5) Femoral Hernias: Which is less common but more prevalent in females, occurring below the groin.
6) Obturator Hernias: Which is rare but severe and often leads to bowel obstruction.
7) Diaphragmatic Hernias: which is a result from congenital defect or traumatic diaphragmatic injury, causing abdominal organs to move into the chest cavity.
The symptoms of hernias typically manifest in the affected area, starting with discomfort or mild pain. A soft lump may be felt when coughing or sneezing and can sometimes be pushed back. The lump may disappear when lying flat, but if it persists, it can become trapped and not recede.
Warning signs of severe complications include persistent pain in the hernia area, inability to push the hernia back, abdominal pain, bloating, vomiting or unable to pass gas or stool. Patients with suspected complications should seek medical attention immediately.
The diagnosis of hernias depends on the location of the abnormal passage of the hernia. If it’s in the anterior abdominal wall, a physical examination by a doctor may be sufficient. For hernias in deeper locations or cases with a thick abdominal wall, additional diagnostic tests such as ultrasound or CT scan may be necessary for a diagnosis.
Treatment of Hernias:
Currently, the primary treatment for hernias is surgery. The standard surgical approach involves repairing hernias by using surgical mesh to enhance strength and reduce recurrence. There are two main techniques:
Open Surgery: A traditional open incision on the abdominal wall to repair or reinforce the weakened area and apply external surgical mesh. Recovery time and postoperative pain may be longer, but it can be performed under local or regional anesthesia.
Laparoscopic Surgery: This minimally invasive procedure uses small incisions and a camera to repair the hernia with internal mesh. Advantages include quicker recovery and reduced postoperative pain compared to open surgery allowing patients to return to normal activities sooner.
“The urgency of hernia treatment depends on the type and symptoms. Delayed treatment can make it more challenging and may lead to various complications, such as incarceration hernia or strangulation, resulting in compromised blood flow to internal organs, requiring emergency surgery.
Additionally, all hernia patients with associated risk factors should be managed for optimal treatment outcomes. The patients should monitor themselves for any abnormal symptoms and seek timely medical intervention to prevent complications.” Dr.Nattaporn concludes.
