HERNIAS - Full extract 

A hernia is general term that covers a multitude of bulges in different areas. It simply means the protrusion of an organ, or part of an organ, through somewhere it should not be.

By far the most common type is a groin or inguinal hernia. Some basic anatomy makes it easier to understand how this type of hernia occurs. Where the leg joins the abdomen there is a strong ligament, known as the inguinal ligament, than runs from the top of the pelvis across to the pubic bone. Under this ligament are the main blood vessels and nerves that pass into the leg. Just above the inner part of the ligament is an internal opening through which, in the male, the vas deferens (spermatic cord) and other structures pass into the scrotum. Before birth the testicles migrate down this track. Although it usually closes off fully, it does remain a weak spot through which structures such as the bowel might protrude.

Congenital inguinal hernias are common, affecting up to three per cent of male babies. Because of the risk of some bowel getting caught and obstructed, surgical repair is advised. It is the most common childhood operation, often performed as an outpatient procedure. Inguinal hernias also occur in later years, perhaps due to straining associated with heavy lifting or constipation, being overweight or just getting older. They appear as a lump or bulge in the groin, usually more obvious when the patient stands and coughs. They can cause a dragging pain and can vary in size from a marble to a grapefruit. Sometimes the bowel inside the hernia extends right down into the scrotum.

Hernias with a narrow neck are more likely to block and obstruct and they should be repaired. A painful lump that persists, even when lying down, suggests that some bowel may have become caught and obstructed. There may be some associated vomiting. This is a surgical emergency because the bowel may strangulate, causing the person to become critically ill.

In simple terms, a hernia operation involves poking any protruding bowel back through the weak spot and closing the opening so it cannot pop through again. Several techniques are used; larger hernias may even require the insertion of special nylon mesh to strengthen the area over the weak spot. Some older patients prefer a truss as an alternative to surgery. But these should only be used for hernias that are unlikely to obstruct and they must be properly fitted; a poor fitting truss can cause problems of its own.

Hernia repairs are increasingly being performed as day surgery cases and a variety of anaesthetic types can be used. They can be repaired under general, spinal or even local anaesthetics. Because hernias can recur, any predisposing factors like chronic coughing or straining should also be corrected. Resting after the operation is important - about three to six weeks depending on the person's occupation.

Hernias can also occur below the inguinal ligament, right next to where the main blood vessels and nerves pass into the leg. These are called femoral hernias and are more common in women than men. Because they are prone to become obstructed, surgical repair is usually advised.

Young children can also have hernias in the region of the umbilicus. Umbilical hernias look like prominent belly-buttons and most settle without treatment. However, hernias slightly removed from the umbilicus usually require surgery, because they have a higher risk of obstruction.

After any abdominal operation there is a risk that the deeper layers of the scar can separate and allow some bowel to protrude. This is called an incisional hernia. Usually the hernia has a wide neck but there is still the risk of bowel becoming caught, and surgical repair may be advised. Again, any aggravating factors should be corrected as well.

Hiatus hernias often get a mention when hernias are discussed. These are actually internal hernias and they occur when the upper part of the stomach protrudes alongside the lower oesophoagus or food-pipe. They are very common and often cause no symptoms at all. Any associated reflux or indigestion should be treated; surgery may still be required for hiatus hernias that are very large or are causing a lot of discomfort.

Health Tips:
* A lump in the groin that comes and goes may be due to a hernia.

* A hernia that becomes obstructed often causes a painful tender lump in the groin. This is a serious condition that usually requires urgent surgery.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001