What is a hernia?

A hernia is an abnormal protrusion of tissue such as intestines through a weakened section of abdominal wall.

Symptoms that may indicate a hernia:

• Bulges, lumps or swelling
• Pain
  Discomfort in the area of a hernia. The pain usually reflects the abdominal contents getting caught or pinched in the hernia. Sometimes pain can occur in areas where the hernia is not present, this is due to the nerves being irritated and causing referred pain. Activities including lifting heavy objects, standing for extended period of times and straining the abdominal muscles may exacerbate pain.
• Strangulation
  When the contents (i.e. bowel or fat) of a hernia are trapped and not able to be reduced, the blood supplying the contents is impaired causing pain and swelling. This results in continuous pain and an irreducible lump. This requires emergency attention.

Hernia Management

• Medical
  For patients that are asymptomatic or the have health issues that make surgery high risk.

• Surgical
  The most common treatment is laparoscopic (key hole) surgical repair with mesh. This is performed using small incisions in the abdominal wall and the use of a camera and instruments through the incisions to perform the repair. The mesh reinforces to affected area to reduce the chance of a recurrent hernia. The advantage of a laparoscopic repair includes less tissue trauma and inflammation, less recurrent hernia risk and shorter recovery.
  Infrequently hernias will require an open repair approach. This is performed through a incision extending from the skin to the muscle in order to reach the hernia base. The hernia content is then reduced through the hole and the hole closed. A mesh may then be used to reinforce the repair.

Hiatus Hernia

The diaphragm’s weakest point is a small opening (hiatus) that allows the passage of the oesophagus from the chest to the abdomen. A hiatus hernia occurs when a section of the stomach protrudes through the hole into the chest cavity.

There are two main types of hiatal hernias:

• Paraoesphageal hiatus hernia- occurs when the lower part of the oesophagus and upper part of the stomach stay in their locations but another part of the stomach squeezes through the hiatus, next to the oesophagus. This is the less common type of hiatus hernia.
• Sliding hiatus hernia- caused by the lower part of the oesophagus and the upper part of the stomach rising into the chest through the hiatus.

​Causes of a hiatus hernia

• An inherited weakness in the surrounding muscles
• injury to the area
• Intense pressure on the surround muscles, ie. coughing, vomiting or lifting heavy objects

Symptoms

A hiatus hernia may be asymptomatic or can cause the following symptoms:

• Chest pain
• Gastric reflux
• Heartburn
• Vomiting
• Abdominal pain
• Belching

Severe complications of hernia

• Incarcerated hernia- The stomach may become stuck in hernia with compromised blood flow leading to gangrene and perforation of the stomach in which emergency surgery is needed.

Investigations

A hiatus hernia can be diagnosed via a gastroscopy, barium swallow or CT.
​
Treatment

A hiatus hernia is usually can be managed with lifestyle modifications and medications although can require surgery depending on the size of the hernia and if it is symptomatic.

• Lifestyle- avoid large meals, spicy food, carbonated drinks, reducing weight and cease smoking
• Medication- to neutralise stomach acidity can be used
• Surgical- Laparoscopic hernia repair​

Umbilical Hernia

Umbilical hernia’s are common in adults and are unlikely to resolve without surgical intervention. Surgical intervention is required when the hernia causes discomfort and pain, blood flow is interrupted or the hernia is large enough to cause disfigurement. Alternatively, umbilical hernias without symptoms may be watched.
​
Umbilical hernia repair can be performed via:

• Laparoscopic surgery
• Open Surgery

​Recovery post surgery

Usually after a hernia procedure you are able to go home either the same or next day.

Incisional Hernia Repair

An incisional hernia occurs after a previous incision to the abdominal wall. Occasionally over time, the incision site weakens causing a hernia in the abdominal wall.
​
Abdominal organs such as omentum or intestine can protrude through the hole and create a visible lump. Pain and discomfort may be felt around hernia site and without surgical intervention there is a risk of fat or part of the intestine becoming incarcerated and therefore making the hernia impossible to reduce or push back in.
​
Incisional hernias can form weeks, months or years later and can vary in size and are usually repaired laparoscopically. A mesh is used to decrease the risk of recurrence due to the less tension created when placed underneath the defect by reaching beyond the edges. The benefits of this include a quicker recovery, shorter hospital stay and less chance of recurrence.

Inguinal Hernia

An inguinal hernia occurs when there is a weakness in the abdominal wall in the inguinal region (groin).
​
What causes an Inguinal Hernia?

An Inguinal hernia can be caused by many different factors such as exercise, straining, excessive coughing or be congenital.
​
Inguinal Hernia Treatment:

• Asymptomatic hernias can be monitored.
• Hernia belts may be used for patients unsuitable for surgery.
• If symptomatic, surgical repair is common and recommended. This is usually laparoscopic with mesh placement.