Doctor’s column: What you should know about hernia

What is hernia?
Hernias erupt when a weakened abdominal muscle tears open, permitting the organs inside to push through. Typically, a hernia will pouch out, looking like a balloon beneath the skin. Two areas are especially vulnerable. Inguinal hernias appear at the point where the leg joins the abdomen. Men feel this type of hernia as a lump in the scrotum. Umbilical hernias crop up at the navel. Surgical scars present yet another opportunity for hernias, in this case called incisional hernias.

What are the common types of hernia?
You may have also a diaphragmatic hernia or a hiatal hernia which is responsible of a reflux. The risk of not repairing a hernia is to strangle the bowel inside it which will need an emergency surgery and may require a bowel resection. An umbilical or inguinal hernia repair is known medically as a herniorrhaphy.

Which are the latest techniques in use nowadays?
• Open herniorrhaphy: In this approach, a single long incision over the hernia is made, the protruding sac is removed if necessary, and the torn muscle are closed. A mesh may be applied to the inside of the muscle wall to strengthen it.
• Laparoscopic herniorrhaphy: This version of the procedure is accomplished through small incisions. With the aid of a tiny lighted scope, the surgeon uses miniature surgical instruments to make the repair from within the abdomen. A mesh is inserted through the ports and fixed by sutures or staples.
• For hiatal and diaphragmatic hernias: The typical operation consists of putting back the protruded organ (most of the time, the stomach) in the abdominal cavity, closing the gap by sutures or a mesh, and doing an anti-reflux valve if it is a hiatal hernia.

Which type of hernia repair is best? And how long it would take to cure?
In Burjeel Hospital, Dr El Zaqui Ladha, a general and laparoscopic surgeon usually perform the procedures through laparoscopy. The operation lasts around one hour; it is usually performed under general anaesthesia, though spinal anaesthesia can be done for an open inguinal herniorrhaphy. The hospital stay is typically for 24 to 48 hours after the laparoscopic surgery, depending on the general status of the patient.

Is there any risk involved during the surgery?
The risk of the surgery is the classical risks, consisting of haematoma and infection. However, if the hernia isn’t repaired, there’s a chance that a portion of the intestine will get stuck in it. As the blood supply gets compromised, this tissue could eventually die, leading to a life-threatening case of gangrene. The patient can return to normal activities two weeks after the surgery, if it is performed through laparoscopy, in case of open surgery, it may take up to two months.
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Dr El Zaqui Ladha is General and Laproscopic Surgeon at Al Burjeel Hospital