The most common place for a hernia to occur is the abdominal wall. A hernia is a weakness in the abdominal wall that allows the contents of the abdominal cavity to protrude out. Most people with hernia complained of a protruding lump at the abdomen. Abdominal contents like omentum (fatty tissues in the abdomen) and small intestines may enter the hernia when the abdomen pressure increases.
Prolong coughing, straining during urination and constipation can increase pressure inside the abdomen and force omentum or small intestines into the hernia. These abdominal contents slip in and out of the hernia easily in most occasions (reducible hernia). However, emergency can occur when these contents get stuck in the hernia and become strangulated (irreducible hernia).
The most common type of hernia is the inguinal hernia. This inguinal hernia occurs in the groin region and it occurs mainly in man. It is uncommon in women. Another type of hernia is the incisional hernia. Incisional hernia occurs due to poor wound healing after abdominal surgery. The hernia occurs directly over the surgical scar. Other types of hernia like femoral hernia and epigastic hernia are rare.
The symptoms of the hernia depends the severity of the hernia. Early hernia may not have symptoms at all. Patient may feel abdominal discomfort or pain upon exertion like prolonged walking or exercise. A protruding lump can be felt in the abdomen if the hernia is significant in size. The protruding lump typically disappears when the patient lies down. In male patient with large inguinal hernia, the groin lump may extend all the way down to the scrotum. In an irreducible hernia, the pain can be excruciating. If intestines are involved in the irreducible hernia, blood supply to the intestines may be cut off and result in dead bowel in a few hours. This is an emergency and surgery should be performed as soon as possible.
The general recommendation is that all hernia should be surgically repaired, except in very old and frail patients. For patients who are not fit to undergo hernia surgery, they have to wear a truss to keep the hernia in check. For patients who are fit, surgical repair should be performed to relieve the discomfort and prevents complications from occurring.
The conventional method to repair the hernia is via the open method. This is performed via a 4to 5cm incision at the hernia site. A non-absorbable mesh is commonly placed to reinforce the repair.
The key-hole (laparoscopic) method to repair hernia has become very popular over the past 10 years. With a few small incisions, there is little pain after surgery and the recovery is fast. Laparoscopic hernia repair is now routinely offered to patient as an alternative to open repair.
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