What is Hernia & Why its Significance?

The incidence of abdominal wall hernia increase with age with a prevalence of 1.7% for all ages and 4% above 45 yrs old. 75% of the hernia are Inguinal with Men having a lifetime risk of 27% while women 3%.
  • More than 20 million hernia surgery – are performed worldwide in a year, making it one of the most common surgical procedures (Inguinal: 93%; Incisional: 5%; Umbilical:1%)
  • Hernia – is an age-related disease
  • The lifelong cumulative incidence of IH repair in adults is – 27–42.5% for men and 3–5.8% for women

A hernia is a bulge over the abdominal wall caused by a weakness or tear of the muscles which allows organs such as the intestines, fatty tissue inside the abdomen and urinary bladder to protrude through the defect. Patients usually notice a swelling under the skin and may experience pain and discomfort occasionally. Symptoms may worsen after prolonged standing, walking or straining (e.g. lifting of heavy objects).

Most hernias occur as a result of weakness or defect in the muscles of the abdomen since birth. As one ages, this defect is further weakened by strenuous physical activity, lifting of heavy objects or incisions of a previous surgery.

The risk of developing a hernia increases with:

  • Lifting heavy objects/strenuous physical activity
  • Pregnancy
  • Chronic cough (e.g. Asthma/ Chronic Obstructive Pulmonary Disease (COPD)
  • Straining due to constipation or when passing urine
  • Smoking
  • Obesity
  • Taking medications such as steroids

TYPE OF HERNIA

 

 

Groin Hernia

What Type of Hernia may occur?

Hernias are named according to their location on the abdominal wall or occasionally their specific cause.

  • Groin Hernia – There are two types of groin hernias – Inguinal and Femoral. Inguinal hernia is the most common type of hernia and has two varieties:  Indirect and Direct. Indirect hernia occurs through the groin in an area on the muscle where the male testis pierces and descends down during foetal development. Femoral hernia is more common in women and is known to cause acute problems.
  • Umbilical Hernia – This is one of the most common abdominal wall hernias. Women are more commonly affected than men – probably due to a previous pregnancy. This area is particularly weak because of the umbilical cord attachment during birth.

  • Incisional Hernia – This form of hernia develops at the site of previous surgical incisions. The muscles around the incision site becomes weak and may lead to hernia formation. At times, multiple areas of weakness may develop with multiple hernias along the entire length of the scar and these can develop weeks, months or years after the initial surgery. Every subsequent surgery further weakens the muscle and increases the risk of hernia formation.

A hernia is a bulge in the abdomen resulting from weakness of the abdominal wall layers. It may contain a loop of intestine or abdominal fat. The hernia can cause severe pain and other complications that could require an emergency surgery. Both men and women can get a hernia.

HERNIA OVERVIEW

Hernia Overview

Hernias are named according to their location on the abdominal wall or occasionally their specific cause.

  • Midline Ventral Hernia – This can be epigastric (in upper abdomen), para-umbilical (around the umbilicus), supra-pubic (in lower abdomen) and sub-xiphoid (just below the rib cage in the midline).
  • Spigelian Hernia – This occurs through the spigelian fascia which is just beside the rectus muscles of the abdomen. The hernia lies in between two muscles of the abdominal wall and is hence difficult to diagnose clinically. The surgeon may need to perform an ultrasound or computed tomography (CT) scan.

  • Rare Hernia – This includes Lateral hernia, obturator hernia, lumbar hernia, sub-xiphoid hernia and parastomal hernia.

DIAGNOSIS

Spigelian Hernia

Diagnosis

Hernia can be diagnosed in most of the cases with a physical examination. In recurrent hernia, complex cases or in certain group of patients (obese, patient with previous surgery, etc) an Imaging Diagnosis (Ultrasound, CT scan , MRI) can be necessary.

Most hernias need to be repaired surgically to treat symptoms and prevent complications (e.g. strangulation of the intestine). Truss or abdominal binder are just temporary measures while awaiting surgery or for very high risk patients.

In Our Hernia Centres, besides Open and Laparoscopic (Keyhole) Surgery, we perform novel surgical techniques such as Single Incision Laparoscopic (SILS) Hernia Repair, Robotic Surgery and Muscle Release Surgery like Endoscopic Component Separation, Transversus Abdominis Release among others.

Your surgeon will determine the treatment options suitable for you after a thorough examination of your cases.

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