Tahir Khan, consultant general and vascular surgeon at the Mater Private Hospital in Cork, explains abdominal hernia, its causes, surgical management, and aftercare.
AN abdominal hernia is the protrusion of tissue from its normal space through the abdominal wall.
In the abdomen, a hernia usually involves a piece of bowel or the omentum, which is a layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen.
The hernia protrudes through a weakened area in the abdominal wall. The abdominal wall is made up of several layers of muscle and tissue.
These weakened areas develop in these muscular layers, allowing bowel in the abdominal cavity to pass through and herniate.
The most common hernias are in the groin — inguinal hernias — and in the diaphragm — hiatal hernias.
Hernias may be present congenital or, more commonly, they may develop at any time later on in your life.
Hernias are most common in the abdomen, but can also appear in the upper thigh, around the naval, and in the groin area.
Generally, hernias are not immediately dangerous, but they don’t resolve on their own and often require surgery to prevent serious complications.
Abdominal hernias can develop in anybody at any age, though most occur in middle-aged and older men. They are diagnosed by clinical examination.
If you have a concern your family doctor can palpate the abdomen to check for abnormal protrusions.
Any activity that increases pressure on the abdominal wall may result in a hernia: Coughing, lifting heavy objects, straining during a trip to the bathroom, or from being overweight.
Often hernias are painless, but can be associated with nausea and vomiting.
Some hernias can be reduced by being pushed back into place; others can not and become incarcerated. If the opening of the incarcerated hernia is so tight that it cuts off the blood supply to the intestine then it is classified as a strangulated hernia.
This is very serious and needs urgent surgical intervention. In non-urgent cases your family doctor may suggest hernia surgery if you have pain or your hernia bothers you during your normal daily living.
Occasionally your doctor may recommend conservative management, but these hernias often do not go away on their own, and may even increase in size.
There are two main options in respect of surgery: ‘open’ and ‘laparoscopic’.
During open surgery, the surgeon makes an incision close to the hernia. The hernia is located and separated from any abdominal tissue close to it. The hernia sac is removed or the hernia is gently pushed back into your abdomen.
The surgeon then closes your weakened abdominal muscles with stitches. Often a piece of mesh is also sewn into place to help strengthen your abdominal wall.
In laparoscopic surgery, the surgeon makes several very small incisions in your abdomen through one of which they can pass a device called a laparoscope, a tube with a light and a camera on the end that allows the surgeon see inside the abdomen.
The other small incisions are used to pass the surgical tools used to perform the operation.
Most people are able to get out of bed an hour or so after this surgery. Often patients can go home on the same day, however some may need to stay in hospital overnight.
Following surgery, you will be advised to return to light activities initially and to certainly avoiding strenuous activities and lifting heavy objects for a few weeks. Avoid doing anything that can increase pressure on the abdomen.
Also, if possible, avoid sneezing or coughing forcefully and support your abdomen with your hands. You will be encouraged to drink plenty of fluids and eat lots of fibre to prevent constipation.
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