What is Hernia Surgery?
BDS (Bachelor of Dental Surgery), 6 years of experience
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What is the meaning of Hernia Surgery?
A hernia is the protrusion of a part of an organ through the wall that contains it. The commonest type of hernias is an abdominal wall hernia, which includes, ventral, lateral (or lumbar) and inguinal hernia. Hernia surgery usually involves repositioning the displaced part of the organ, back to its original place. Different procedures are attempted depending upon the type, size, and severity of the symptoms experienced due to the hernia. Once the bulge is pushed back into the body part that should contain it, the patient is relieved of the pain and discomfort. This helps the patient optimize his/her quality of life and attain the maximum level of physical health.
In today’s article, let us tell you in detail what hernia surgery is.
- What causes Hernia?
- What are the types of Hernias for which Surgery may be performed?
- What is the purpose of Hernia Surgery?
- What are the risks involved if Hernia Surgery is not performed?
- How is Hernia diagnosed?
- What are the types of surgeries performed for Hernias?
- What are the precautions taken after Hernia Surgery?
- What are the possible complications of Hernia Surgery?
- How much does a Hernia Surgery cost in India?
What causes Hernia?
Abdominal wall Hernias most commonly occur due to weakened muscles. These could have been present since birth in which case they are called Congenital Hernias. They also occur in adult life due to aging and repeated exertion on the abdominal and groin areas. Strain may occur due to physical exertion, pregnancy, obesity, coughing or sneezing frequently, or straining on the toilet caused by constipation.
What are the types of Hernias for which Surgery may be performed?
The term abdominal wall Hernia can also be used to describe the protrusion of a hollow or solid viscus through a defect in the abdominal wall musculature. Some of them are as follows:
- Inguinal Hernia: In men, this occurs in relation to the inguinal canal which is a passageway for the spermatic cord and blood vessels to the testicles. In women, this inguinal canal consists of the round ligament which is present to give support to the womb. In an inguinal hernia, fatty tissue or a part of the intestine protrudes into the groin at the top of the inner thigh. Inguinal Hernia is the most common type of hernia. It affects men more than women
- Femoral Hernia: A part of the intestine may protrude into the groin region at the inner part of the thigh. These hernias are not as common as inguinal hernias. They affect older women
- Umbilical Hernia: A part of the abdominal contents, be it the small or large intestine protrudes out near the belly button
- Epigastric Hernia: A protrusion is seen in the area between the sternum above and below the navel
- Incisional Hernia: Protrusion through a scar formed due to a previous surgical operation or accidental trauma
- Interstitial Hernia: The sac, maybe a continuation of inguinal or femoral hernia wherein it passes between the layers of the anterior abdominal wall
- Spigelian Hernia: Protrusion through the region below and lateral to the belly button
- Lumbar Hernia: A hernia that comes out of Petit’s triangle, an area in the lower part of the back
- Obturator Hernia: This hernia comes out through the Obturator Foramen which is an opening created by the hip bone for the passage of nerves and blood vessels
What is the purpose of Hernia Surgery?
The purpose of hernia surgery is to rectify the defect caused by the displacement of the organ and reposit the organ back to its original position. This in turn will relieve the patients of their symptoms. Hernia surgery is advised to the patient based on symptoms like:
- A bulge at the site of hernia
- Severe discomfort at that area along with pain.( Know more about- What is Pelvic Pain and Home remedies for Pelvic Pain ?)
- Bulge increases in size while bending, standing, coughing, etc.
- In the event of intestines getting stuck in the hernia defect, patients may present with nausea and vomiting occurring due to intestinal obstruction.
What are the risks involved if Hernia Surgery is not performed?
Hernias do not disappear on their own (except for umbilical hernias in babies). Hernias require surgical intervention, as there is no medical treatment available for the same. If they aren’t treated in time it could result in an increase in size, more painful presentation or even life-threatening complications.
Complications of untreated inguinal or femoral hernias are:
- Obstruction (incarceration): In this case, a part of the intestine gets stuck in the inguinal canal. This results in stomach pain, nausea, vomiting, and a lump in the groin region
- Strangulation: Here a part of the intestine is trapped in that small space which results in cutting off the blood supply to that part. In these cases, emergency surgery (within hours of occurring) is performed to prevent the death of the tissue.
How is Hernia diagnosed?
An abdominal wall hernia is seen as a visible bulge on the surface of the skin. It may be small initially but grows over a period of time. It appears as a localized mass protruding out. Depending upon the size and the type it may be noticed by the patient while having a bath or changing clothes. As it increases in size additional symptoms are experienced including pain, discomfort, and inability to pass stools.
The following tests confirm the presence of a hernia:
- Physical examination is sufficient for confirming inguinal or ventral hernias. The doctor will be able to see the bulge when a patient tries to stand or strain
- A cough impulse test is performed wherein the doctor places his finger at the site of protrusion and asks the patient to cough to see if the herniated sac will protrude out due to that impulse
- The diagnosis of Internal hernias is done by CT scans
- CT scans (plain) without contrast have now become the gold standard investigation for abdominal wall hernias
What are the types of surgeries performed for Hernias?
There are four types of surgery that can be done to treat a hernia. These include herniotomy, herniorrhaphy, hernioplasty, and laparoscopic surgery. Before surgery anesthesia is given to numb the region.
Spinal, general, or local anesthesia can be given. Spinal anesthesia is given through an injection of the spine. For general anesthesia, the drug is injected using the IV attached to the vein in the hand. In local anesthesia, the drug is injected at the site of the surgery.
At times, a catheter is passed through the urinary bladder before the surgery and kept there for the collection of urine. This is done mainly for large hernias. The skin is then cleaned and draped before the incision is made.
The 4 types of procedures are as follows:
- Herniotomy: In this procedure, the surgeon first identifies the sac that protrudes through a defective opening. He then tactfully pushes the sac with the contents back into that region so that it is confined to the walls. If the sac is open it should be closed. This surgery results in the highest recurrence. It is the most preferred treatment for Congenital Hernias which are hernias present from birth.
- Herniorrhaphy- Like Herniotomy, the sac is identified. The surgeon then pushes it back into place, within the walls that should contain it. The surgeon sutures two edges of the opening together. This can be easily done if the edges are in closer proximity to each other. If the two edges are widely spaced, the sutures tied could result in increased tension as a result there is a displacement of the sutures and opening of the hernia, and the protrusion, through already weak muscles, can happen again. Hence this procedure is said to increase the risk of recurrence. This is the most preferred surgery in infected or strangulated hernias. This procedure is also called open hernia repair surgery.
- Hernioplasty– In this procedure, the sac is identified and pushed in. It is also closed in case there’s an opening. Instead of suturing the two edges, a mesh is put over the defect. This thereby reduces the pressure created on the muscle wall that occurs due to stretching and increased tension of the two edges. It hence reduces the chance of recurrence. This technique is called- Lichenstein’s tension-free mesh hernioplasty. The mesh material used may be synthetic or biological. Synthetic mesh is avoided when there is infection and strangulation while biological mesh can be used when there’s an infection. Examples of synthetic mesh are materials like polypropylene, polyester. Examples of biological mesh are organic biomaterials like human or animal donor tissue.
- Laparoscopic surgery – In this procedure, a small incision is made under the navel. A device called a laparoscope is then inserted through the incision. Multiple small incisions are made for equipment to be inserted to treat a hernia. This is then covered and closed with the help of a synthetic mesh. Laparoscopic surgery is even possible for large and complex abdominal wall hernias without excess loose skin, wherein small incisions are created over the skin and the procedure is performed through these incisions. ( Know more about– What are Diagnostic Laparoscopic Gynecological Surgeries? )
- Laser Treatment for Hernia– Laser -guided system allows surgeons to precisely place the mesh and stitches in the repair of ventral hernias which gives better results in laparoscopic ventral herniorrhaphy (LVH) compared to visual estimation based hernia surgeries.
What are the precautions taken after Hernia Surgery?
- In most cases of hernia surgery, the patient is discharged on the same day or 1-2 days after surgery. The recovery time differs for different procedures. In the case of open surgery, it takes about 3 to 4 weeks. After laparoscopic surgery, the recovery time is much shorter as the incision is smaller and fewer tissues are damaged. In large and complex hernias, a drain may be placed which is removed between postoperative days 3-10 based on the patient’s condition and recovery.
- The patient should refrain from doing any physical activity which involves bending, lifting heavy weights, strenuous exercise, etc after surgery.
What are the possible complications of Hernia Surgery?
Hernia Surgery is a routine procedure very commonly performed. However, like every other surgery, it comes with a fair share of complications. Complications of hernia surgery are as follows:
- Difficulty in urination ( Know more about- What is Urine Pain ? )
- Bleeding or some other discharge from incisions
- Fluid in the stomach and later pain
- Difficulty in breathing
- An allergic reaction that occurs due to anesthesia or medications which is used during and after surgery
- Infection at the surgical site
- Stomach ache
- Backache ( Know more about- What is Coccydynia ( tailbone pain ) ? )
- Bladder injury by mesh. ( Know more about- What is Urinary Bladder Cancer Treatment? )
If the mesh used in surgery is rejected by the body, then symptoms are as follows:
- Swelling
- Lump(s) formed around the area of surgery
- Fever
- Nausea
- Vomiting
If you experience any of these symptoms after surgery, then contact your doctor immediately.
How much does a Hernia Surgery cost in India?
The cost of hernia surgery in India ranges from INR 1,50,000 to INR 3,50,000. Many prominent hospitals and doctors in India offer hernia surgery. It is a very common surgical procedure. The cost varies across different hospitals.
If you are coming from abroad, apart from the cost of hernia surgery, you will have to bear the additional cost of living in a hotel and local travel. After surgery, the patient will require two days of hospital stay, and five days of hotel stay for recovery. So, the total cost of hernia surgery in India can range from INR 1,80,000 to INR 3,80,000.
We hope your questions on Hernia Surgery were answered through this article.
You can contact a General Surgeon for more information and treatment of Hernia Surgery.
We only aim to give you information through the article. We do not recommend medication or treatment in any way. Only a doctor can give the best advice and treatment plan.
