Hernia

What is a hernia?

A hernia is experienced as a bulge or swelling of the abdominal wall caused by protrusion of abdominal content (fat or intestine) through a body wall that normally contains it. Hernias occur due to weakness of the muscle wall, tissue or membrane. Hernias are also more common in certain parts of the body where weak points exists namely in the groin and belly button area. They can also develop along scars lines due to incision from a previous operation.

What are the different types of hernia?

Common types of hernia include: 

Inguinal Hernia – more common in men where a bulge appears in the groin or scrotum due to a weak points in the abdominal wall where the spermatic cord courses through.

Femoral Hernia – less common groin hernia than inguinal hernia but more commonly observed in older women. The weak point is where the blood vessels to the thigh and leg pass through the bottom of the pelvis in a region known as the femoral canal.

Umbilical Hernia – a bulge that occur around the umbilicus (belly button) where the belly button is described as an “outie”. This can be present from birth or acquired as a result of straining the abdominal wall.

Incisional Hernia – Scar tissue from previous surgery is weaker than the surrounding muscle and can tear to form a hernia. 

What are the symptoms of a hernia?

Symptoms of hernia include the presence of a lump, pain, discomfort, “dragging” sensation, incarceration (cannot be reduced) or strangulation.

How do you treat a hernia?

Hernias when small can be easily reduced by pushing the hernia contents back through the abdominal wall defect. However, as it enlarges and becomes long-standing, the hernia contents can no longer be reduced and this causes discomfort and/or pain. This irreducible hernia is described as incarcerated. When the hernia contents are irreducible and contents are being constricted by the defect such that there is compromised of the blood supply to the contents within the hernia, this is termed strangulation where there is often significant swelling and severe pain.

A/Prof Terence Chua conducts physical examinations of all hernias to evaluate the type of hernia and determine the best method to repair the hernia either by keyhole or open surgery. At times, imaging such as ultrasound and CT scans are performed to further characterise the hernia, especially in patients with recurrent incisional hernia. The information obtained from imaging aids in operative planning such as during a recurrent hernia repair by component separation (Rives-Stoppa repair).