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Hernia

Description

A hernia is a protrusion of an organ or part of an organ into an abnormal location. A hernia can occur in many locations around the body but occurs most commonly through the abdominal wall.

Types

Inguinal hernia

This is the most common hernia through the abdominal wall. A bit of intra-abdominal fat or a loop of small intestine can protrude through the inguinal canal leading to a lump in the groin. An inguinal hernia is much more common in men. It can occur at any age. It can occur on one or both sides.

Femoral hernia

This is a less common type of groin hernia more common in women. A lump in the groin occurs that is slightly lower to where an inguinal hernia occurs.

Umbilical/paraumbilical/epigastric hernia

These hernias are caused by weakness and/or defects in the midline of the abdomen at or near the umbilicus (belly button).

Incisional hernia

This is a hernia that occurs through a defect in the abdominal wall over a previous surgical incision.

Parastomal hernia

This is a hernia that develops adjacent to a colostomy or ileostomy.

Causes

Hernias often arise in areas of inherent weakness. They may be precipitated by increases in abdominal pressure. They occasionally occur through a single traumatic event but much more commonly they occur as a gradual process over months to years. Anything that increases intra-abdominal pressure can lead to a hernia. This includes obesity, heavy strenuous activities, coughing and constipation.

Complications

Often hernias do not cause any symptoms apart from a small bulge. This is usually in hernias that can be reduced (ie the bulge can be flattened when lying down or pushed back in manually). Other hernias can cause pain or discomfort (often a dragging sensation) especially after standing for prolonged periods of time. Hernias can get bigger over time and become unsightly in some.

The most serious complication of a hernia is that of incarceration and strangulation. This is when the components of a hernia (usually small intestine) gets stuck and cannot be pushed back (incarceration). If the hernia is not reduced then the bowel can become gangrenous (strangulated). This complication presents as severe pain over a hernia (bulge) that cannot be pushed back. It is a surgical emergency and should not be ignored. Medical attention is urgent as an incarcerated bowel can start to die within 6 hours. Fortunately, most hernias are at low risk of this complication.

Investigation

The majority of hernias can be diagnosed by clinical examination. Occasionally, an ultrasound (or CT scan) can help detect a hernia or is used to look for one on the opposite side.

Treatment

  • There is no other way to repair hernias other than by surgery. Not all hernias, however need to be fixed.
  • Asymptomatic small hernias can be left alone. Some of these will not get bigger or cause symptoms. If symptoms occur, then a further assessment should be made.
  • Symptomatic hernias and ones that are at higher risk of incarceration (femorals) should be repaired.
  • Incarcerated (irreducible) hernias are a surgical emergency and need to be repaired immediately.
  • Hernias can be repaired by either open surgery or laparoscopically (keyhole). Laparoscopic surgery has the advantages of smaller incisions, less pain, earlier return to normal activities and work.
  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: 1300 553 347
Fax: (02) 9650 4924

Double Bay

Double Bay Day Hospital Specialist Suites
Suite 3.01, Level 3, commercial
451 New South Head Road
Double Bay

Phone: 0290 863 133
Fax: (02) 9086 3123

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