Types of Hernia
Inguinal Hernia (Female & Male)
An inguinal hernia is a common type of hernia, causing a lump and sometimes pain in the groin.
A femoral hernia is an uncommon type of hernia. Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin.
An umbilical hernia is normally a painless swelling in or near the belly button.
An epigastric hernia is a lump in the midline between the belly button and the breastbone which can cause pain.
An incisional hernia is hernia occurring through a previously made incision, ie. the scar left from a previous operation.
A spigelian hernia is a very rare abdominal wall hernia that usually arises to the right of the belly button, between the three layers of the abdominal wall.
A lumbar hernia is a very rare condition with fewer than 300 cases reported. The defect arises at the back of the abdominal wall where the muscles join the muscles of the back.
A ventral hernia is a bulge through an abnormal opening in the wall of the abdominal muscles at the top of the abdominal wall.
Divarication of the rectus occurs when the two sides of rectus abdominus muscle forming the abdominal wall separate. It is common in pregnancy and is only a problem if the muscles do not come back together again in their correct position.
Type of hernia repair:
How it is performed? – hernia surgery can be carried out either by open or keyhole (laparoscopic) surgery. Surgery can be performed under general or regional (local) anaesthetic and is dependent on the type of hernia, patient suitability and patient preference. This will be discussed thoroughly during your consultation with Mr Bailey. He will also discuss the various options available for the appropriate treatment of the hernia from which you are suffering.
Open Surgery – open hernia surgery can be carried out under a general anaesthetic which means you will be asleep during the procedure and won’t feel any discomfiture. It can also be carried out under local anaesthetic, where the area around the hernia is numbed, so that you will not experience any pain but will be awake during the procedure, or a regional anaesthetic which is injected into the lower part of the spine which numbs the lower half of the body.
Tension free mesh repair – this technique, also known as the Lichtenstein hernia repair, has been performed since the late 1950s and it involves reducing the hernia and reinforcing the repaired musculature by the placement of a piece of prolene mesh to reinforce the repair and reduce the risk of recurrence.
Natural tissue repair – this technique is also known as the Shouldice hernia repair, as pioneered by the Shouldice Hernia Hospital in Canada some 70 years ago. The procedure is performed by the open technique and the hernia is reduced in a similar way to the Lichtenstein repair, but rather than placing a mesh, the layers of the abdominal wall are individually sewn together using a technique that puts virtually no immediate or long term tension on the natural tissue. Mr Bailey will be able to discuss the recovery and the risk/benefit equation of natural tissue versus meshed hernia repair with you to determine the optimal choice of operation. A shouldice hernia repair is only performed for inguinal (groin) hernia surgery.
Laparoscopic or keyhole surgery – general anaesthetic is used for keyhole hernia surgery, so you will be asleep during the operation. Mr Bailey usually makes three small incision (5mm – 1cm) in the abdominal wall, just below the belly button and uses the totally extra peritoneal approach which involves repairing the hernia without entering the abdominal cavity. It does require the placement of a mesh.
Which Technique is Best?
The National Institute of Health and Care Excellence (NICE) which assesses medical treatments for the NHS within the United Kingdom says that both keyhole and open surgery for hernias are safe and work well. With keyhole surgery, recovery times tend to be quicker, however the risk of more significant complications are slightly higher than with open surgery. The risk of the hernia recurring or returning is similar after all techniques. Mr Bailey will discuss with you which technique is appropriate for your condition, taking into consideration your health in general and the type of hernia with which you present. At all times it is important that you are aware of the risk/benefit equation and the potential complications and convalescence required following hernia surgery so that you can make an informed choice about what sort of operation (if any) is needed in your circumstance. Should you have any questions about any of the types of operation, please don’t hesitate to contact us via the website or discuss it at the time of your consultation.
At times lumps and bumps can appear on your body and while most lumps are benign (non cancerous) it is important to have them checked to be sure of exactly what they are and whether or not they need treatment. Examples of benign skin lumps include:
- Sebaceous cysts: skin lumps filled with fluid.
- Skin nodules formed by inflammation of the skin.
- Lipoma: small lumps of fat cells.
- Fibromas or fibro adenomas: lumps of fibrous or glandular tissue.
- Haematoma: a lump formed by blood escaping into the tissue (a large bruise).
- Haemangioma: a lump formed by extra growth of blood vessels.
- Papilloma: a lump of skin or internal membrane cells, for example.
Surgery for Lumps and Bumps
It is usually performed as a day case procedure, under local anaesthetic, using minimally invasive techniques with the aim of removing the lump or bump and causing minimal scarring. Options for treatment will depend upon the cause.
Painful ingrowth of the nail (usually of the great toes), can result in repeated infections and pain caused by rubbing, particularly in shoes. It is easily treated with a simple day case operation, usually done under local anaesthetic to remove part of the nail causing the damage to prevent recurrence of symptoms in the future.
Pilonidal disease is a condition where hairs collect in small pits under the skin. This is nearly always between the buttocks in the tail bone region. The pit usually has a small opening on to the surface of the skin. This is called a pilonidal sinus. Hair, sweat and (if there is infection) pus can come out through the sinus.