What is a hernia?
A hernia occurs where there is a weakness in your abdominal or tummy wall. As a result, some of the contents within the abdomen can then push through under the skin. They are very common and can occur at all ages. The risk is strangulation of an organ, especially the intestine.
Where are hernias located and why do they occur?
There are several types of hernias which can form on weak parts of your tummy wall. Typical locations are the groin, the navel, the tummy midline or at a scar. Hernias in adults usually arise as a result of increased intra-abdominal pressure caused by strain, and resulting in a weakness or tear in the abdominal wall. Reasons may be:
- Persistent coughing
- Being overweight or pregnant
- Lifting, carrying or pushing heavy loads
- Straining on the toilet
Do they need treatment?
Although having a hernia is not usually a serious condition, surgical closure of the hole in your tummy wall is the only way to treat a hernia. If the hernia is left untreated the natural course of the disease is a constant increase of its size and a risk of strangulation.
What are the symptoms?
You may notice a small soft swelling under the skin in one of the typical areas. Hernias often appear after a strain or just spontaneously, without any reason. Most people feel a light sensation of discomfort or pain over the swelling. At first you can usually push the hernia back through the hole and which goes in with a watery noise. When intestine is trapped in the hole, the hernia gets strangulated. This means, blood an oxygen supply to the trapped intestine is cut off causing severe pain, nausea and vomiting and absence of bowel movements, indicating acute bowel obstruction. A strangulated hernia is a medical emergency and you have only a few hours to have surgery with a risk of having have to remove part of your intestines.
What is the treatment?
The only cure to a hernia is surgery and it is always preferred to have a hernia repaired before it becomes an emergency. There are two types of surgery currently available and they are one of the most common procedures performed by surgeons today: Open surgery and laparoscopic surgery.
- Open surgery can be done to fix all types of hernias; the procedure is rather simple and consists of suturing the muscles or closing the defect with a reinforcing mesh. It is an easy procedure with a minimal risk of recurrence when a mesh is used and a minimal risk causing damage to intra-abdominal organs. The disadvantages are that the procedure is more painful, scarring is more extensive, and there is also the risk for wound infection.
- Laparoscopic or key-hole surgery, is a newer technique that can repair all types of hernias as well. Rather than one big incision, the surgeon will make three tiny cuts, the largest of which is only around 1.5 cm in size through which a mesh is then inserted to close the hole. The advantages are very small scars, faster healing, less pain when compared to open surgery, extremely low risk of wound infection and reduced risk of recurrence. You can usually go back to normal activities within just a couple of days. The disadvantages are that it is a difficult procedure not many surgeons know how to do and the surgery is performed close to intra-abdominal organs with a very low risk of wounding them. Laparoscopic hernia repair is contraindicated in large inguinal-scrotal hernia or in patients who have previously undergone pre-peritoneal surgery such as prostatectomy, pre-peritoneal hernia repair.
- The anesthesia needed during hernia repair depends on the location and technique. It can be either local, spinal or general. Laparoscopic procedures are usually performed under general anesthesia.
- In rare cases any kind of surgery or anesthesia may be contraindicated. This may be the case in elderly persons who have other important diseases. For such patients a truss, which is practically a strong belt holding the hernia in place from the outside, may be indicated. Wearing a truss can be quite uncomfortable that is why they are applied rarely.
At the Hanoi French Hospital, we can offer all types. Our expert surgeons have also extensive training and expertise in laparoscopic surgery. Laparoscopic procedures are usually done in day-care and patients can return home the same day. Talk to your doctor to learn which treatment option is the best for you.