Hernia

When there is a weakness in the muscles of our abdominal wall, the internal organs may protrude through this weakness, and present as a lump. This lump typically disappears on lying down and becomes obvious on standing. It is a common problem, not just amongst the elderly, but also amongst the young.

 

General Definition:

A hernia occurs when internal organs within a body cavity protrude through a defect or “hole” (weakness) in the muscular wall of that cavity. This is a very common surgical condition. Depending on the location and the causes, there are different types of hernia.

 

Types of Hernia:

  • Inguinal hernia
  • Umbilical and paraumbilical hernia
  • Incisional hernia
Inguinal hernia

What is it? This type of hernia occurs over the groin region. It may be on the left side or the right side. In some people, it may even be on both sides at the same time.

 

What are the symptoms? The typical complaint is that of a lump at the groin. The lump would typically “disappear” when the patient lies down, but “appear” when the patient stands up or when the patient coughs or sneezes. In the beginning, the lump may be small, but it would usually grow larger with time. Over time, patient may complain of an ache or discomfort over the groin. If the lump becomes painful and it does not “disappear” on lying down, this may be an emergency called strangulation. Urgent medical attention is needed if this occurs.

 

What is the treatment? The only “cure” is an operation to repair the hernia. This involves putting in a mesh, which is a net-like material, to repair the defect or the “hole” in the muscular wall and strengthen the abdominal wall muscles. Hernia cannot be treated with medications. This surgery can be performed by a laparoscopic method (also known as keyhole method) or by the traditional open surgery.

Open hernia repair

This operation is performed through a cut directly over the hernia. The aim is to reduce the hernia (push the contents back into the abdominal cavity) and cover up the defect using a mesh. This is a very common operation. Patient usually needs to stay one night.

Laparoscopic or keyhole hernia repair

This operation is performed through small keyholes, between 5mm to 1cm large). Usually 3 holes are needed. The aim is to reduce the hernia (push the contents back into the abdominal cavity) and cover up the defect using a mesh. This is a very common operation. Patient usually needs to stay one night.

 

The key advantage of keyhole operations over the open method is the smaller scars, which may mean less pain and earlier return to usual activities.

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Umbilical / Paraumbilical hernia

What is it? This type of hernia occurs over or around the umbilicus (the belly-button)

 

What are the symptoms? The typical complaint is that of a lump directly over the belly button or around the belly button. Patients would sometimes say that their belly button appears to pop out when they stand. The lump would disappear when they lie down. Over time, it may get bigger. If the lump becomes painful and it does not “disappear” on lying down, this may be an emergency called strangulation. Urgent medical attention is needed if this occurs.

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Incisional hernia

What is it? This type of hernia occurs over a previous surgical scar made over the abdomen. Whenever a surgeon performs an operation in the abdomen, e.g. removing the appendix for appendicitis, he has to cut through the skin as well as the muscles to get to the abdominal organs. The surgeon will repair the muscles by stitching the muscles together when he finishes the operation. Sometimes, the repair may weaken over time, and this results in a hernia – this is called an incisional hernia.

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