Hernia

Hernia signifies a bulge of tissue, usually the intestines or fat under the skin through a natural or acquired opening in the abdominal wall.

CAUSES: it is formed due to congenital weakness of soft tissue structures, or it is developed over a lifetime. It is usually located in the groins, around the belly button or on in the area where surgical procedure was previously done. Location determines the name of the hernia. There are areas on the abdominal wall that are predisposed to develop hernia due to their anatomic build.

RISK FACTORS: age, sex (groin hernia is 10 times more common in men, while femoral hernia is more common in women), increase in abdominal pressure due to lifting heavy objects, difficulties in defecation and urinating due to constipation, strong and long-lasting cough, obesity, pregnancy.

SYMPTOMS: bulging area, pain, feeling of weight in the groin while standing or straining, swelling can lower towards the scrotum in men. Incarcerated hernia – acute, urgent condition: strong groin or abdominal pain, nausea, vomiting, flatulence, fever, increased heart rate.

GROIN / INGUINAL HERNIA

Makes up 75% of all abdominal hernia and it is about 25 times more common in men than in women. It is divided into two groups: direct and indirect. Both are found in the groin, but have different starting points. Both hernias look similar, as a bulge in the groin, so the type is sometimes difficult to determine.

Indirect inguinal hernia is formed due to congenital weakness of the inner inguinal ring and can occur at any point in life. It is discovered at birth in 1% of boys, which is connected to descending testicles. It is located in the lower parts of the abdomen right above the groin, close to the pubic region. Sometimes it can appear on both sides; then it is called bilateral.

Direct inguinal hernia is a consequence of the DNA weakness of the inguinal canal and it is mostly formed in older patients because anterior abdominal wall weakens with age. The abdominal wall is naturally thin in that area. It rarely descends into scrotum.

FEMORAL HERNIA

The femoral canal is a part through which the femoral artery, vein and nerve when they leave the abdominal cavity and come to the upper leg. This is a normally tight space, but it sometimes can be so large, that organs of the abdominal cavity pass through it. It is presented as bulging below the groin crease in the medial part. It is usually more common in women and carries higher risk of complications than inguinal hernia.

UMBILICAL HERNIA

Frequency between 10-30%; often visible at birth as bulging around the waist. This happens when the opening on the abdominal wall, which should normally be closed, does not close completely. If it is small, it usually closes until year 2. Those that do not close are large from the beginning so they need to be operated between the ages 2-4. This hernia can develop in adults as well, due to weakness of this area of anterior abdominal wall or in women after childbirth.

VENTRAL/ABDOMINAL HERNIA

Surgical procedures done on the anterior abdominal wall can later lead to hernia in that area. Statistics show 2-10% of possibility of occurrence after surgical procedure.

OBURATOR HERNIA

This is an extremely rare type of hernia, most commonly found in women. The content passes through the oburatory canal. Because there is no classical bulge with this type of hernia, the first sign of its existence can be intestinal obstruction, delays (nausea and vomiting).

EPIGASTRIC HERNIA

There is a bulge in medial line of the abdominal between the belly button and lower rib arc. It often contains fat, very rarely bowels. It is formed in the zone of relative weakness of the anterior abdominal wall and it is often painful.

TREATMENT

Hernia can be completely cured only surgically, and it is, at the same time, one of the most common surgical procedures.

Surgical procedures can be divided into tension, tension-free and laparoscopic.

Tension procedures are done by pulling the surrounding tissue on the hernia opening after which a scar is formed that prevents reoccurrence of hernia. The most famous ones are hernioplasty according to Bassini and Shouldice. Nowadays they are performed only in younger patients. This procedure has a large number of relapse, up to 15%.

Tension-free procedures are done with the aid of synthetic surgical material in a form of a .

Mesh is a surgical material that can be made of: non-absorptive material (polypropylene, goretex), absorptive and combined materials. These sterile meshes are soft, flexible and can be adapted to bodily movements. Meshes are so firm, that immediately after the installation they enable normal return to activities including sports. Many varieties in shape and size are possible. They can be in a form of a patch that is placed over or under hernia opening, or in a form of a cork that is inserted in the hernia. Mesh is used in tension-free, as well as laparoscopic procedures. Hernias differ from patient to patient, so one system of mesh is not suitable for each hernia. Surgical procedure and type of mesh are determined for each individual patient based on anatomical test results.

LICHTENSTEIN METHOD

One of standard surgical tension-free procedures done under general intravenous, or possibly, local anesthesia.

Description of the procedure

Surgical process has two stages. In the first stage, hernial sac is presented and her content is taken care of. In the second stage, mesh is placed over the opening of hernia.
Advantage of this method is its minimal invasiveness and complete view on the working area. The incision is about 5 cm long.

Preparation

Act according to instructions previously given by an anesthesiologist: the day before the procedure, after light supper, it is, perhaps, necessary to take a mild laxative in order to ensure morning defecation. In the morning, it is advised to drink 3-5dl of Donat Mg and after that, stop taking liquid and eating. Common therapy, if necessary, take according to standard scheme or according to the arrangement made by anesthesiologist during the preoperative exam.

Recovery

Postoperative course is accompanied by very mild pain; recovery is fast. For the next month, patients should avoid physical effort and demanding physical activity.

Side effects and complications

Relapse is very rare: from 0,5-2%; they mostly occur due to extreme weakness of the abdominal wall.

As with other surgical procedures in this region, bleeding of different volume is possible. But, with correct preparation of the patient and adequately performed technique by an expert surgeon, this complication is negligible.

Package

Package includes: preoperative examination by an anesthesiologist, procedure itself, thromboprophylaxis if necessary, analgesics for 1-2 postoperative days and control examinations during the next 6 months.
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