What is a Hernia?
A hernia is an abnormal bulge or protrusion on the body.
The most common type is the inguinal (groin) hernia.
The Inguinal Hernia
This occurs at the groin through a weakness of the abdominal wall muscles near the pubic bone, called the inguinal region. This appears as a lump in the groin and usually occurs over months to years. Symptoms develop when it becomes large enough as more contents come out and this can include fat or even intestines as the hernia enlarges.
Some of the common symptoms include:
- Dull aching sensation at the groin, with pressure or a feeling of ‘heaviness’
- When the intestine protrudes towards the scrotum, it can causes pain down to the area surrounding the testicles
- These symptoms tend to worsen with straining, e.g. coughing, sneezing, lifting heavy objects, constipation etc
Normally, the appearance of a hernia becomes more obvious in a standing posture, due to gravity and especially when coughing or straining as mentioned above. However, this can improve with a change in posture like lying down.
Treatment of Inguinal Hernia
The method of choice for treating hernia is surgery. This surgery involves reducing the protruding hernia contents and placing a mesh (plastic scaffold) to reinforce the weakened muscle layers. This can be done using the conventional open technique where a cut is made over the groin bulge. Today, the preferred option when feasible is using laparoscopy or keyhole surgery to perform the procedure.
In addition, it is important to address any factors contributing to the hernia such as straining, including chronic cough, constipation and lifting of heavy weights. This will improve results of surgery and reduce the risk of recurrence.
Surgery can be performed using the conventional ‘open’ technique, where a cut is made over the protruding hernia to push back (or sometimes remove the protruding contents), repair the weakened tissues and placing the mesh for better support. This can be done as a day case under general anaesthesia. After surgery, the patient is advised to rest and avoid strenuous exercises and straining activities for at least the next 4 to 6 weeks.
This procedure is also carried out under general anaesthesia. In this process 3 small 1cm incisions are made in a straight line from the belly button downwards. A slim high-definition camera (laparoscope) is put into the abdomen through one hole, with 2 slim operating instruments placed through the other 2.
The hernia is repaired in a similar way but from within and a mesh is also placed to strengthen the weakened areas. Since the procedure is done through smaller cuts, there is less pain and overall recovery time is shorter compared to the conventional technique.
This procedure is particularly useful for those with bilateral hernia as both sides can be repaired using the same cuts. Recurrent hernia, particularly those done previously with the conventional open technique, are also better done using the laparoscopic method as it will avoid going through old scar tissue and mesh, which could further complicated the repair.