A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.
A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.
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.
Shouldice Hernia Repair
This procedure is for groin hernia repairs using your natural tissue, without the use of a surgical mesh. The defect is repaired using an anatomical approach utilizing the body’s own tissue to repair the hernia defect. The procedure was first pioneered 70 years ago at the Shouldice Clinic in Canada and the technique involves stitching the three separate layers of the abdominal wall in the groin region individually, using a technique that puts virtually no immediate or long term tension on that natural tissue and does not require reinforcement with a mesh. The recovery from this technique is similar to open meshed and laparoscopic hernia repairs.
A great deal has been written recently in the press about mesh placement and the potential long term complications thereof, secondary to foreign body reaction, movement of the mesh, post-operative pain and so forth and Mr Bailey would be more than happy to discuss the risk/benefit equation of each form of approach for hernia repair with you, so that you can make an informed decision as to which method would be best in your circumstance. It must be noted however that it is not always possible to effect a mesh-free repair if the damage to the muscles of the abdominal wall is so severe that reconstruction without a mesh is not possible. Mr Bailey would discuss that and any other risks and complications with you during your consultation and should you have any questions, he would be more than happy to answer them for you at any point.
A great deal has been written in the press recently about the complications of mesh placement following hernia surgery. It is firstly very important to realise that 20 million hernia surgery operations are performed per annum worldwide, the vast majority using mesh to reinforce the repair. The incidence of post-operative chronic pain, ie. Pain that last more than 2-3 months after surgery, is extremely small. There are a number of possible causes for chronic post-operative pain, all of which Mr Bailey would be happy to discuss with you during your consultation.
Before determining whether surgical intervention is appropriate for patients with post-operative chronic pain syndrome secondary to mesh placement, it is essential to assess the severity and impact this has on the quality of the patient’s life. There are a number of options for treatment including pharmacological interventions, radiological guided injections, radiofrequency ablation, with surgery being used as a last resort.
There are different surgical approaches which can be used, which include removal of the mesh, or performance of a neurectomy or a combination of the two. During your consultation Mr Bailey will take a careful history, examine you carefully and may organise for you to have further investigations and questionnaire to assess the cause of your problem to determine which is the most appropriate management pathway for you, surgery is not always the answer.
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.