What is a Hernia?

Hernia is a condition that happens when the small intestine starts to move or push itself. However, this action causes fat and peritoneum flow to the side of scrotum or pubes. The common hernia is inguinal hernia, which may occur to patients since they were born. This type of disease happens in males caused by many factors: pregnancy, a male fetus’s testis canal is unable to be closed, the testicle is moved down to the scrotum, the weakness of the abdominal wall, exertion, chronic obstructive pulmonary disease, chronic cough, obesity, constipation, enlarged prostate and diseases with collagen abnormality. At the same time, in females the umbilical hernia can also happen which it can spread or occur in other areas as well

What cause hernia?

• • Deficiency of adhesion inside the abdominal wall.

• • Increased pressure inside the abdomen.

• • Abdominal muscle abnormalities.

• • Pregnancy, obesity, coughing, sneezing or heavy lifting which all increase more pressure inside the abdomen.

• • Constipation and urinary tract obstruction

What are the symptoms of a inguinal hernia?

• • Bulged lumps may be found only in the area of scrotum or pubes with slight pain or no symptoms at all.

• • While standing, walking, or exercising patients often find themselves having the lumps in the area of the groin. The lumps may disappear while lying and it can be pushed by hands.

• • Severe pain, the lumps cannot be pushed (incarcerated hernia) along with vomiting and no defecation. These may occur due to intestinal obstruction of the hernia.

• • Strangulation, which requires an emergency surgery.

Diagnosis of hernia

At first, the doctor will ask patients about medical history or record. Then the physical examination will be performed by making the patient stand, later, it may be necessary to insert their fingers into inguinal canal (Figure 1) In fact, patients require to flex the abdomen or cough during an examination. However, the hernia has to be checked on both sides, if having inguinal hernia, this type of hernia can be treated after being found immediately. On the other hand, in case of unclear cause in obese people and those who have had hernia surgery, some additional examination may be needed, such as ultrasonography, CT scan, or MRI.

Alternative treatment for hernia

The treatment is applied for locating the intestine back to its original site. A puncture will be provided to tighten the hole or reinforce the weakness of muscle as well as fibrosis.

However, in case of patients with incarcerated hernia. The treatment is made by patients and surgeons. The patient needs to lie down the body, and receive muscle relaxant, painkiller, and sleeping pills, while the surgeon will use fingers pressing on the intestine to push it back to the position.

Moreover, if the hernia has infarction, many treatments methods are required: removing the bag of hernia, and suturing to repair the inner wall including the surgery for hernia repair are a must as when the hernia is left for too long, it may lead to decomposition as well as dead skin.

SURGERY: The most effective treatment for hernia.

The only way to cure hernia is by surgery. There are two main types of hernia surgery as follows:

1. Open Technique
The doctor will perform the surgery and push the intestine back inside. Later the hernia bag will be sewed, while some defects will be repaired either by tissues attaching or free-tension surgery by using sheet. The hernia sheet helps reduce a change of disease occurrence better than attaching the tissues.

Besides, there are also surgical procedures. In all cases, patients may have about 6-8 cm size of an ulcer; on the groin area where the hernia is located. This surgery may require anesthesia and spinal anesthesia.

Moreover, severe pain may occur in the wound area, also long recovery is needed before returning to normal life. In addition exercise and sport are still allowed to do.

2. Laparoscopic Technique
There are two different ways of this technique: an operation without accessing to the abdominal area and a procedure that requires abdominal accessing. The patient will have one 1.5 cm small incision or wound as well as two 0.5cm incision(Figure 2). However, during a process, the surgeon will set the hernia bag back to the abdominal cavity and put the sheet by holding it with metal pins. In fact, the laparoscopic surgery often requires anesthesia as well.

Advantages of Laparoscopic Technique

In case of severe bleeding and severe inflammation which the surgical camera is unable to be inserted, open surgery then will be provided to the process.Normally, a physician will treat patient bases on the disease. However, the laparoscopic surgery has following advantages over open surgery:

• Small lesions only 5-10 mm.

• Less tissue damage including the chance of fibrosis in the abdomen.

• Less pain after surgery.

• Less complications.

• Reduce the rate of recurrence

• Repair all types of hernia

• Rehabilitation in the hospital only 1-2 days, but some cases can return home immediately after recovery.

• Within a week, patients can live normally and if there is no pain within 2-4 weeks, exertion and sport then are allowed to do.

DR. HASUN MOOHAMAD

General Surgeon

Phyathai 1 Hospital

Call +662-201-4600 ext. 2185, 2285