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Surgical hernia repair

What is a hernia?

A hernia is a weakness or tear in a muscle wall that allows the ‘insides' to bulge or squeeze through. Acquired hernias are caused by wear and tear and congenital hernias result from a weakness present at birth. Hernias commonly occur at the groin or beneath an old surgical scar. When the pressure on a hernia rises, the bulging tends to increase.

What is a hiatal hernia?

Hiatal hernia occurs when the top end of the stomach pokes upwards through the diaphragm into the chest area. Often this causes no symptoms and requires no treatment, but it can cause heartburn, belching, reflux and other problems. If symptoms do not respond to drugs, surgery is an option.

How do hernias form?

A loop of your intestine can push against a weakened or torn area of muscle to form a bulge. This bulge may disappear when you lie down or press against it (a reducible hernia). A minor hernia may show no bulge - you might feel only a burning or tingling sensation. In this case, an ultrasound test can often detect the hernia.

If more intestine bulges through there is a possibility it will not slide back inside when the pressure on it is reduced. This is called a non-reducible hernia, a permanent (trapped) bulge that may be painful. A further complication is when the contents of a non-reducible hernia become twisted or strangulated.

Are hernias dangerous?

A minor hernia is not dangerous but it tends to become more bothersome and will not heal by itself, so it will still need to be repaired. If you have a non-reducible or strangulated hernia you will need prompt surgical attention – you should see a doctor immediately. A strangulated portion of intestine can lose its blood supply and die, block digestion and cause severe pain; fortunately, this is uncommon.

What can surgery achieve?

By visiting your doctor for a medical examination the type of hernia can be diagnosed and a timetable for repair agreed upon. If you are young or you remain active, surgical repair is usually recommended, but it is possible your medical history may mean some types of surgery are not a suitable option for you. Belts and pads that apply pressure to keep the hernia from bulging can be worn, but this is really a temporary measure.

Surgical hernia repair involves strengthening the area of weakened or torn muscle by sewing the muscle to a nearby ligament. Often a synthetic mesh is sewn into the weak spot and scar tissue grows into this mesh to strengthen the area. Today, such surgery is frequently done laparoscopically (keyhole surgery) using three small cuts rather than one large cut, which allows a quicker recovery and less pain and scarring. Some small repairs can be done using only a local anaesthetic.

Being ready for your surgery

Until it is repaired you should avoid lifting or putting strain on your hernia - follow your surgeon's instructions. You may need a check up a few days before surgery, and you will be told when to stop your usual medications, including pharmacy medicines (eg, aspirin). You will need to stop eating and drinking, probably on the night before surgery - your surgeon can confirm this. Hernia repair can be an outpatient procedure but a stay in hospital may be needed for larger repairs.

After the operation

You may be sore for a few days, so take it easy. If a certain movement hurts, don't do it. With inguinal (groin) hernia repair, bruising may spread to the genitals but don't worry, it will go away. If there is increasing pain or redness around a wound, you should call your doctor or surgeon.

Original material provided by UBM Medica (NZ) Ltd. Reviewed in January 2002 by Robert J Fris.

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