Dr Arthur Richardson - Hepato-Biliary, Upper Gastro-Intestinal and General Surgeon Associate Professor,University of Sydney
 
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Hernia Repair (Surgery)

A hernia is the abnormal protrusion of bowel or other tissue through a tear in the wall of the cavity which contains it. There are different types of herniae but the most common is an inguinal or groin hernia, which is more common in men. Other types of herniae include naval (umbilical), in the midline (epigastric) or at the site of a previous operation (incisional).

Signs and symptoms

Most patients notice a bulge or swelling in the groin. This may be more obvious with standing and may disappear with lying down. Some groin herniae may be quite painful. Occasionally bowel or other tissue may be caught in the hernia and become irreducible. If the blood supply is cut off they are said to be strangulated and this will be painful with vomiting. In this situation urgent surgery is required.

Causes

Some groin herniae are congenital and may present in children. In adults, groin herniae may be related to straining due to lifting, severe coughing or problems with constipation and prostatic hypertrophy. Smoking, obesity and poor nutrition may also predispose to groin hernia.

Diagnosis

Most groin hernia will be diagnosed with physical examination, but occasionally an ultrasound or CT will be required.

Treatment

A small groin hernia may not require repair but if it is increasing in size or causing pain, repair may be indicated. The treatment for most groin herniae is surgical repair as trusses and supports are often not comfortable in the long term. There are many different types of repairs described but for practical purposes there are two main techniques:

  • Laparoscopic (keyhole) repair: this requires a general anaesthetic and a muscle relaxant. Several small incisions are made in the abdomen and a laparoscope is inserted. Via a video monitor the hernia is defined and a piece of plastic mesh is placed to cover the defect. Most patients require an overnight stay and recovery at home will take one to two weeks. There are advantages and disadvantages of laparoscopic repair versus open repair.
  • Open surgery: this involves a groin incision and a piece of mesh is sutured over the hernial defect. This can be done with either a local anaesthetic or a light general anaesthetic. Many patients can be discharged on the day of surgery although some will require an overnight stay. Recovery at home will take one to two weeks and return to work will depend on the type of work. This method of hernia repair may have the lowest risk of recurrence which should be a lifetime risk of recurrence of less than five per percent.

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