Hernia Surgery at Woodthorpe Hospital
At Woodthorpe Hospital we offer the most up-to-date treatment options for hernia sufferers. We have an excellent experienced team of surgeons who practice the most modern, well proven techniques in hernia surgery.
The testaments from our patients are most complimentary about the caring attitudes of our staff and the quality of service we offer.
We believe that patient education and information is a very important part of our service so that patients can make a choice about where, how and when they wish their hernia to be treated. Most hernias can be treated on a day case basis under local or general anaesthesia, depending on patient choice and their medical background
What is a Hernia?
A hernia is a protrusion of contents of a cavity through a weakness in its walls. Most hernias occur in the abdomen. The site of hernia usually indicates its type.
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Below is a description of common abdominal hernias and the treatment options for our patients.
Inguinal Hernias appear as a lump in the groin and they can cause pain. Even though some are painless they can eventually lead to complications. The smallest ones that fail to be spotted may cause pain. (eg in sportsmen) but as they get bigger pain and discomfort is a usual feature
Most doctors would advise to have the Inguinal Hernias treated surgically because they can lead to troublesome complications. The feared complication is strangulation when part of the bowel gets its blood supply cut off and this then becomes a real surgical emergency. You may lose a part of the bowel and if untreated and it can be fatal.
Treatment is usually surgical but nonsurgical treatment is appropriate for people who may wish to avoid surgery due to ill health or as a temporary measure on a trial basis. This usually consists of wearing a hernia belt during wakeful hours of the day.
There are several options for surgery which can be performed under local anaesthesia or general anaesthesia. It can be open surgical or via the key hole (laparoscopic) technique but the usual method used is the well proven nylon mesh repair in either technique. Your surgeon will be able to help you decide the best option for you and it is usually a day case procedure unless of course your health or aftercare warrants an overnight stay.
Femoral Hernias usually occur in women, due to the wider pelvis in women. Femoral Hernias are usually much smaller in size than inguinal hernias but are more dangerous and even more painful. They strangulate easily and need treatment urgently. They appear as a small lump in the groin crease and complications such as intestinal obstruction are common. They are not easy to find and are sometimes missed by doctors.
Treatment for this condition is surgical and is a fairly simple operation as a day case procedure.
Umbilical Hernias are very common and do not always need treatment. In childhood they are usually observed and not treated surgically as most will disappear by about 4 years of age and even the large ones may close spontaneously. However, if they cause pain or other symptoms surgery may be required. They occur more frequently in certain ethnic groups eg Afro–Caribean children and are also more common in children born prematurely. Adults with Umbilical Hernias (called Paraumbilical Hernia) can be left alone unless they cause symptoms.
Umbilical Hernias can be unsightly or become painful and they can continue to enlarge and cause bowel obstruction and the enlargement may occur with weight gain. Complications from Umbilical Hernias increase with its size with strangulation being the feared complication when a part of the bowel or fatty tissue has its blood supply cut off. Pain and vomiting are usual symptoms in this situation and urgent treatment is required which could be lifesaving.
Umbilical hernias in children and Paraumbilical hernias in adults are treated differently. In children even the relatively large Umbilical Hernias rarely cause any trouble and close off on their own at about 4 years of age. If they persist then surgery is appropriate.
In Adults not all Para Umbilical Hernias need treatment but sometimes surgery is the only treatment possible. Surgery can be open surgical with an incision which is appropriate to the size of the hernia. Laparoscopic surgery is also used to treat these hernias and general anaesthesia is required unless it is a very small hernia.
Epigastric and Ventral Hernias
Epigastric hernias are not uncommon. They may appear as a lump above the umbilicus and below the notch in the middle of the lower margin of the rib cage. (Zyphi sternum) Divarication is usually due to a separation of the two muscle bands (Rectus abdominis) that run on either side of the umbilicus. This is also sometimes called a Ventral hernia and can be present from birth although it may become more prominent with weight gain.
Epigastric hernias can often be symptomless but most patients will seek treatment as they do not like the lump or may have some discomfort.
Divariication of recti usually doesn’t cause any symptoms and can be left alone but if there is an associated epigastric hernia, then surgery is appropriate.
Open surgery is usually a very simple procedure for this and it is done under General anaesthetic although a local anesthetic may also be appropriate for some patients. It involves a small incision over the hernia to close the defect and it may or may not require a nylon mesh to strengthen the repair. It is a day case procedure and return to normal work should be possible within one week but heavy lifting etc should be avoided for another two to three weeks.
Incisional hernias are fairly common following previous abdominal surgery and they are especially prevalent if healing of the wound was complicated by infection. They are also more common following emergency surgery. The site of the hernia depends on the site of the operative scar.
Some incisional hernias are not troublesome and if so they can be left alone. They are often unsightly but a majority of these get larger with time and can become symptomatic or cause strangulation. Incisional hernias come in all sizes and shapes and they can keep enlarging. Only parts of the incisional hernia may be painful. When they are large, pain may also occur elsewhere eg back pain as the bowels that get into the sacs pull on its attachments. Therefore, pain may be prominent when you are upright and is relieved when lying down. These symptoms can make you less active and gradually affect your health and make you put on weight. Pain is not related to the size. Occasionally you may not even see a bulge but have pain related to a previous incision. It is best to get it checked by a doctor or a surgeon who may request an ultrasound scan or a herniagram to detect a small hernia.
Incisional hernias can be dangerous as they can cause strangulation and bowel obstruction. They may also be associated with internal adhesions and in these situations emergency surgery is required. Repair of incisional hernias in such emergency situations are prone to recurrent incisional hernia formation and part of the bowel may also need to be removed..
Treatment is usually surgical and smaller incisional hernias are easily corrected with open surgery usually as a day case procedure. Sometimes it may be possible to consider treatment through laparoscopic or key hole surgery. It is best to try and lose excess weight before surgery. A common technique is to close the defect and secure the weakened area of the abdominal wall with a synthetic mesh. Rarely it may be necessary to repair the abdominal wall with a procedure called Abdominal wall reconstruction.
Sportsmen often report painful groins. A sports hernia is one of the causes of groin pain which persists or recurs after other treatments such as physiotherapy fails to resolve the symptoms. Often a bulge may not be detected and an ultrasound scan maybe required for diagnosis. The hernia is due to a small defect in stretched tissues through which a lump of fat may protrude especially during exercise.
The surgeons may advise repair usually after a course of physiotherapy. Treatment is usually similar to the repair undertaken for Inguinal hernia with the insertion of a nylon mesh to strengthen the weakened tissues.