Hernias
Dr. Konkin has taken a special interest in hernias and abdominal wall reconstruction. Below is some basic information regarding hernias. He provides a tailored approach to each individual depending on their hernia and other medical conditions.
Hernia Definition
A hernia is a defect between the muscles of the abdominal wall, resulting in a bulge.
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Common types of hernias are:
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1) Umbilical hernia: Located at the belly button where it appears as a round lump of fat pushing the belly button outward. This is one of the most common hernias.
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2) Inguinal hernia: In this type of hernia the bulge appears in the groin, and it is more common in men than in women.
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3) Femoral hernia: This type of hernia is more common in women than in men. The hernia normally appears below the groin as a fixed lump.
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4) Incisional hernia: This occurs after surgery and is usually a failure of the abdominal muscles to heal.
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5) Sports hernia (athletic pubalgia): This is not a true hernia but presents with similar symptoms to a regular inguinal hernia. This is a soft tissue injury to the groin which often occurs during sports that require sudden changes of direction or intense twisting movements. There are a number of groin injuries that cause pain and it is important to have a multidisciplinary assessment including a surgeon to determine the diagnosis and management strategies.
Hernia Symptoms
The following are common symptoms of a hernia:
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1) An aching sensation on the abdomen or the groin that is more apparent when you are active, bending over or lifting things.
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2) An obvious swelling beneath the skin of the abdomen or groin that is visible while standing up. Most of the time the bulge can be pushed in, or it goes back on its own when you lie down.
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If the hernia becomes extremely painful and hard then it may be incarcerated or trapped. This means that the fat or loop of intestine is now stuck in the hernia and is in danger of becoming gangrenous. This is referred to as strangulation. If you suspect that your hernia may be incarcerated or trapped, then you should seek medical help immediately.
Hernia Treatment
1. INGUINAL hernia repair:
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There are two surgical methods for inguinal hernia repair.
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Open Technique:
The most traditional and still the most common technique is to make an incision over the bulge and isolate the hernia. The advantages of this technique are that surgeons have used it on hundreds of thousands of patients and it most often can be done under local anesthesia. The disadvantage is that it is very painful during the first two days after surgery and it takes about 4 weeks to return to heavy activity, including physical jobs and sports.
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In the last 25 years it has become common to use a mesh to repair the weak tissue around the hernia. This is a "tension-free" repair so hurts less in the first few weeks vs primary sutures. It also has a significant less chance of your hernia returning (recurrence).
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Laparoscopic Technique:
In appropriate patients, repair of the hernia can be done from inside the abdomen with a laparoscope. This instrument is about as big around as the tip of your little finger, and has a lens with a light at its tip. The operation is done under general anesthesia only. The advantages of this technique are that there is less pain in the first 2 days, the return to normal activity is about 2-3 weeks. It is an excellent operation for patients who have hernias on both sides and hernias that have recurred following an open repair. The disadvantages are you need to be asleep for the operation and there is a small risk of damage inside the abdomen. The operation is more difficult to learn and is done by only a small group of surgeons, including Dr. Konkin. Mesh is always used in laparoscopic repair.
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2. UMBILICAL hernia repair:
Most umbilical hernias are repaired as day surgery, either with local anesthetic and sedation, or general anesthesia. An incision is made below the umbilicus and the hole is repaired with sutures alone or with mesh. Some bruising and swelling should be expected. You will be able to get back to basic activities within a couple of days. Heavy exercising and physical work will take a couple of weeks. Small hernias are repaired with sutures. Larger umbilical hernias require mesh to limit chance of recurrence.
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3. INCISIONAL hernia repair:
The incisional hernia may occur in the area of any prior surgical incision, anywhere on the abdomen, and can vary in size from very small, to very large and complex. The surgery to repair it is done using general anesthetic and requires that the patient will be admitted to the hospital for two to three days. Mesh is usually part of the repair, and drains are placed in the wound for a few days to take away any fluid. As with most hernia operations it takes about a month to get back to heavy physical work or exercise. There are some indications for either a laparoscopic method or “component separation”, which is a more dynamic repair. Dr. Konkin has taken a special interest in more complex hernia repairs. He will discuss which would be the best method for you. Mesh is always used for incisional hernias as without it, there is almost a 100% recurrence without.
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NON-OPERATIVE MANAGEMENT:
Some hernias can be managed without an operation, particularly if they are painless. However, there is still a small risk of incarceration/strangulation which may lead to the need for emergency surgery. Also care needs to be taken when performing heavy lifting. A hernia belt or truss can control the symptoms of an inguinal hernia allowing you to avoid or postpone surgery.
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This information is for general educational purposes, please ensure you seek medical/surgical advice prior to deciding how best to manage your hernia.