HERNIA

KINDS OF HERNIA

There are several kinds of hernias. However the common hernias of the abdomen are

hiatus     hernia. Click HERE     if you wish to know about hiatus hernia. Otherwise read on. The next two     will be discussed below. inguinal     (or groin) hernia and     incisional (or ventral) hernia.

INGUINAL HERNIA

The groin is a natural weak spot for all upright people. This is much more so for men than women because the testicles start out being on top of the kidneys and travel down into the scrotum before birth. In their travels they leave a tract. Usually this tract closes up or fibroses, but occasionally it fails to close and sometimes remains wide open. This results in a groin hernia or tendency to hernia development. Even when the tract is fibrosed, it tends to be weaker than normal tissue, and thus is likely to give after years of repeated pressure. This is why hernias are commoner at the extremes of age - in the young and again in the old. In the young we see those hernias which have been left open since birth, and in age we see those which have given way to life's repeated pressures at a time when general tissue weakening is beginning to tell.

INCISIONAL HERNIA

Incisional hernias occur when previous surgical incisions break down. A scar is never as strong as the original tissue (even if it looks thicker) and therefore all incisions are at some risk of breaking down. If they do, an incisional hernia is the result. Wound infection, obesity, constipation, prostatism, asthma, bronchitis, cancer, chemotherapy, ascites, cirrhosis and malnutrition are but some of the risk factors associated with incisional hernia formation. Often these are massive in size, usually much larger than inguinal hernias.

THE PROBLEM

Many hernias produce pain and prevent exertion, interfering with normal life. However, pain and discomfort aside, hernias are dangerous, presenting an actual threat to life. The usual substance which herneates or protrudes through the hernia, is bowel. So long as it can return without difficulty, the danger is small. However, should gut protrude through the hernia and then become twisted or kinked in a manner which prevents its return to the abdomen, the situation could in quick order become dangerous. Bowel obstruction could ensue, and the associated swelling may increase the pressures so that blood flow to the trapped bowel is stopped. Gangrene of the bowel ensues, with perforation, sepsis and, even, death. Each year hundreds of people in Canada die from complications of their hernias, yet the number dying from hernia surgery is precious small. Since hernia repair can be done with little risk and under general, regional or local anesthesia, hernias should almost always be repaired.

HOW SUCCESSFUL IS SURGERY?

Unfortunately, surgery is not as successful as we sould like to believe. OHIP data suggest that 20% of inguinal hernia repairs done in Ontario are done for recurrent herniation. Studies of incisional hernia repairs, even in respected major university teaching centres, have shown recurrence rates of 40-60%. This suggests that the principles of hernia repair are often poorly understood and poorly taught. Many general surgeons, because they do a multitude of operations, take less interest in hernias. They learn a method which seems to work most of the time and continue practising it without analysis. A surgeon doing about 20 hernias, or less, a year may have to practice a long time before problems are apparent. He may take pride in his good results and do not see his failures. Unless a surgeon follows up his results meticulously, he will have no idea of his true results.

WHAT ABOUT SPECIALIZED HERNIA CLINICS?

These places certainly have a large experience and have contributed vastly to our understanding of hernias. Unfortunately, in order to maintain consistently good results, many clinics feel obliged to be very selective about their patients. They select only the best patients and turn down those with any risk factors. Consequently, the results published by these clinics cannot be compared in any meaningful way. The obese and the asthmatic patient probably has a higher risk of incarceration and death from his hernia, than the normal patient. Therefore, such patients need their hernias repaired every bit as much as other patients. Yet they are turned down by the hernia clinics and come to their community surgeon for repair. A surgeon who can get good results with high risk patients should be able to get good results with any hernia repair.

WHAT IS KNOWN ABOUT HERNIA REAPAIR?

Thanks to interested surgeons, many principles of good hernia repairs are becoming evident. Although the superspecialized seem to get good results with almost any technique, it seems that techniques which avoid tension are consistently producing the best results, even in the hands of generalists. Most of these techniques use prosthetic mesh as part of the repair, and at this time it would seem that tension-free techniques using mesh procuce the best results. This applies to inguinal hernias, and, even more so, to incisional hernias.

HOW TO CHOOSE A GOOD HERNIA SURGEONDoes     he know what his own recurrence rate is? It should be under 5% for inguinal     hernias and 10% for incisional hernias, preferrably much less. And make sure     the figures include all comers, not just selected patients. Does     he use a tension-free technique? Does     he use mesh? How     many does he do a year? Preferrably over 25. How     many has he done utilizing his present technique? For most experienced     surgeons, a new operative technique can be mastered with 20 cases; for     laparoscopic hernia repair the learning curve is 50-75 operations.

The above guidelines are not guarantees of a good result, nor does their lack preclude a good result. However, they do give some guidance and should increase the likelihood of good result in most cases, if you have no other more reliable yardsticks.

WHY LAPAROSCOPIC HERNIA REPAIR?

This is a tension-free repair, using mesh. Complications are very low, once the technique has been mastered. The repair is a very secure one, with excellent recurrence statistics in our hands. Because the incisions are small and the muscles are left in their natural positions, postoperative pain and discomfort is minimal. It is done as an outpatient procedure and most patients can get back to normal activities within a week. Even strenuous exertion is allowed. Time off work is minimal, very important for the self-employed.

The major disadvantage of this technique is that it is more expensive than other techniques and takes long to master, much longer than other laparoscopic operations. The learning curve is 50-75 operations. If you are to have a laparoscopic repair and want to reduce the likelihood of problems, make sure your surgeon has done at least that many.

Heartburn|Procedures|Directions|Links|

What is a hernia?

Hernia Repair

A Typical hernia is a weakness or tear in the abdominal wall which allows the inner lining of the abdomen to push through and form a sac. The hernia may fill with intestine or tissue which then may become incarcerated or obstructed causing a potentially serious health risk.

Hernias can occur at birth or over time due to stress and strain. There are different types of hernias, but the overwhelming majority occur in the abdominal wall at the groin, the naval, or at the site of imperfectly healed surgical incisions. An easy way to envision a hernia is to think of a tire. When an abnormal opening occurs in a tire, the inner tube protrudes from the opening. Similarly, a hernia occurs when an organ or tissue protrudes through an abnormal opening.

Will I Know If I Have A Hernia?

Hernias are usually easily recognized. You may feel pain when lifting heavy objects, coughing, or straining during urination or bowel movements. You may also feel a bulge under your skin.

How Are Hernias Repaired And What Are My Options?

Hernia repairs are one of the most commonly performed surgeries in the United States. Over 700,000 procedures are completed annually. They can only be completed surgically and are done to relieve the symptoms of pain and to prevent other more serious problems from occurring if the hernia is ignored. However, there are several options available.

Open Surgical Repair

The most common hernia repair being performed today is the open "tension free" repair. This procedure is usually performed under local or regional anesthesia (however, you may be put to sleep) and requires a large muscle cutting surgical incision (two to four inches) to gain access to the hernia. The repair is made by securing a plastic mesh over the hernia defect. The technique is effective, but because the incision cuts through muscle a full recovery can take four to six weeks.

Regular Laparoscopic Repair

A few years ago a minimally invasive procedure to repair the hernia defect became available. This transabdominal approach usually is performed with general anesthesia (you are put to sleep). The surgeon gains access to the hernia internally through the abdomen making three small incisions (one half inch or less). The abdomen is then inflated with Carbon Dioxide gas.

Because these smaller incisions cause less trauma to stomach and groin muscle, post operative pain is usually less and full recovery is achieved much quicker (one week or less). However, one disadvantage of the transabdominal approach is that the laparoscope and other instrumentation needed to complete the repair must be inserted into the abdominal cavity exposing the patient to the risk of possible internal vessel or organ injury.

"Balloon" Laparoscopic Repair

The newest, and most advanced laparoscopic hernia procedure, the extra-peritoneal balloon approach, is now being performed at Norwood Hospital by Dr. Arthur Glasgow, Dr. Peter Lydon, and Dr. Philip Reilly. They have performed over 1500 procedures utilizing this approach over the past five years.

This new balloon device minimizes the risk of transabdominal surgery by creating an operative space outside of the abdominal cavity. This procedure is considered safer for the patient since the surgeon does not have the potential risk of bowel or vessel perforation. Because the operative space created by the balloon approach requires inflating a space much smaller than the abdomen, the use of general or regional anesthesia may be selected. A full recovery can usually be expected within a week.

The instruments used to perform "Balloon" Laparoscopic Surgery, made by ORIGIN©

Lap           Hernia

Traditional           Open Surgery

Hospital Stay

Usually same day procedure

Usually same day procedure

Recovery Time

As little as 1 week

4 - 6 weeks

Scarring

3 small marks

3 inch scar

Postoperative Pain

Minimal

Significant

HERNIA INFORMATION PAGE

A HERNIA SHOULD NOT BE NEGLECTED IT

CAN LEAD TO SERIOUS COMPLICATIONS

____________________________________________________

WHAT IS A HERNIA? HOW DOES IT HAPPEN?

An abdominal wall hernia, or rupture, is noticed as a lump or bulge. It appears when the lining of the abdomen ( the peritoneum ) breaks through a weak spot in the abdominal wall. The name or terminology of the hernia depends on its location:

Groin Hernias are: Inguinal (direct or indirect )

Femoral

Bilateral ( double ) Hernia

Upper Abdomen: Ventral

Umbilical ( at the belly button)

Other: Incision ( results from previous surgery)

Recurrent ( if the hernia was fixed before )

Hiatus Hernia ( a stomach hernia to the chest)

Once the hernia has occurred, it can cause problems as it enlarges. Hernias are more frequent in males, but females can also develope a hernia. The cause of a hernia is a gap or weakness in portion of the abdominal wall (ventral hernia), or by a widening of an opening (inginal hernia). The problem results from the ensuing bulge of intestine. As a person lifts, pulls, or strains, the pressure in the abdomen increases and the bulge enlarges. As the opening increases,more intestine bulges.

Hernias in sports is well known! Groin pain is experienced by most athletes at some time. Football players, weight lifters, golfers, and baseball players all can have acute muscle strain and tears. However, if the pain becomes chronic, or a bulge appears this indicates a hernia. If left untreated, this bulge will become larger with exercise. The hernia should be repaired as early as possible. With the new method of laparoscopy and 3-Dimensioal VR, activities such as lifting and sports can be resumed in just a few days.

Many people say that a hernia can be cured by limiting activities and rest. This may decrease symptoms, but the only cure is surgical repair.

Hiatus Hernia ( GERD ) Heartburn

Besides serious long term effects

constant Heartburn is a way of life!

_______________________________________

Unlike an abdominal wall hernia this hernia, occurs between the chest and the abdominal cavity. It is a portion of the stomach moving up into the chest. As much as 75% of the population many have this hernia. Only about 50% have symptoms. The cause of the problem is reflux of stomach content (acid), up into the esophagus. This happens because the lower esophageal valve or sphincter is distorted by the hiatus hernia. The more reflux, the more inflamed the valve and the more incompetent the valve. If left untreated, the esophagitis develops into an ulcer and cellular changes occur, which is a precancerous condition (Barrette's Esophagus).

What are the signs of a Hiatus Hernia?Heartburn (reflux) is the major problem. As many as 25 million Americans have heartburn everyday! Chest pain and pressure also occur, as does back and shoulder pain. Patients have trouble bending over or lying flat, because the heartburn increases.

The Treatment for Hiatus Hernia (reflux):Lifestyle changes,are the first thing doctors tell their patients. Patient are told to decrease the amount of food and liquid the consume. Nothing 2 to 3 hours before bedtime. Stop eating certain food like coffee, chocolate, peppermint, stop smoking and drinking alcohol. Most patient find that, even if they follow these rules, they get no relief. Medication: In order to deal with the acid reflux, antacids are started. The acid reducing druglike zantac, tagamet, pepsid and axsid, are tried. Coating agents and motility enhance are also tried. Most patients get little long term relief. A major disadvantage of medications is they can create other problems with long term use. Surgery is the only definitive cure for esophageal reflux and Hiatus Hernia. By restoring the lower esophageal valve

(sphincter), and eliminating the hernia, the reflux is eliminated and the esophagitis resolves.

Although the procedure has been successful for over 50 years, before the age of laparoscopy it required a large incision, a week or two in the hospital and a six week recovery. Now with the use of 3D Virtual Reality Laparoscopy, this procedure is a same day surgery with small puncture wounds and one week recovery. Correct diagnosis and rapid treatment are essential.

Hiatus Hernia ... see also Heartburn

What is a hiatus hernia?

A hiatus hernia occurs when the upper part of the stomach, which is joined to the oesophagus (gullet), moves up into the chest through the hole (called a hiatus) in the diaphragm. It is common and occurs in about 10 per cent of people.

What are the symptoms?

Most people are not troubled by their hiatus hernia, but if reflux of the acid contents of the stomach occurs (called gastro-oesophageal reflux), you get heartburn. This is a painful burning sensation in the chest, which can sometimes be felt in the throat. Sudden regurgitation of acid fluid into the mouth can occur, especially when you lie down or bend forward. These symptoms are a problem when you go to bed and can wake you up. Other symptoms include belching, pain on swallowing hot fluids and a feeling of food sticking in the oesophagus.

Who gets a hiatus hernia?

It is most common in overweight middle-aged women and elderly people. It can occur during pregnancy. The diagnosis is confirmed by barium meal X-rays or by passing a tube with a camera on the end into the stomach (gastroscopy).

What are the risks?

Hiatus hernia is usually not serious; however, it can cause inflammation of the lower end of the oesophagus. This is called reflux oesophagitis, and it may cause bleeding (perhaps anaemia) or a stricture. Cancer in a hiatus hernia is very rare, but there is a slight increased risk of it developing in the inflamed area.

What is the treatment?

Keep to your ideal weight. Avoid stooping. Avoid smoking. Reduce alcohol and coffee. Avoid tight corsets. Adjust your bed. Take antacid. Have small meals. Avoid spicy food. Avoid hot drinks. Avoid having supper. Avoid gassy drinks.

Losing weight nearly always cures it. Eating small meals each day instead of 2 or 3 large ones helps. You must have a light evening meal without alcohol and avoid supper so that your stomach is empty on retiring. It takes about 1 hour for the stomach to empty.

Smoking certainly aggravates it, as do coffee and alcohol, especially spirits. If symptoms occur at night, you are advised to use extra pillows to prop up you head and shoulders. If this fails, you should raise the head of your bed about 10 cm (4 inches) to prevent acid reflux at night.

Medical help

If over-the-counter antacids and other measures do not help, your doctor may prescribe a special mixture or tablets to reduce reflux. If your problem persists, an operation (which has good results) may be necessary.