A hernia is an organ that protrudes through the muscle or structure that normally houses it. The majority of hernias arises in the abdominal region, between the hips and the chest. Inguinal hernias, umbilical hernias, femoral hernias, and hiatal hernias are some of the common types of hernias. The most common type of hernia is an inguinal hernia, where a part of the intestine or fatty tissue protrudes from the upper end of the inner thigh.
Femoral and inguinal hernias are located on the upper end of the inner thigh (groin area); umbilical hernias occur near the belly button; and hiatal hernias are located near the chest.
Some of the symptoms of a hernia include the following:
A notable bulge or lump, along with potential pain or discomfort, is a common sign of most hernias. The bulge or lump may not be present all the time; it may disappear when the patient lies down. For example, standing, lifting heavy objects, or putting strain on the body can aggravate symptoms. A doctor can confirm most hernias during the physical exam, but imaging may be required in some cases.
The symptoms of a hiatal hernia are an exemption from the general rule because they do not result in a bulge. Hiatal hernias, on the other hand, can cause symptoms like acid reflux, heartburn, and regurgitation of liquids or food that are frequently treated with medication.
Most hernias need surgical treatment because they are rarely cured on their own. The three main types of hernia repair (hernioplasty) include open hernia surgery, laparoscopic surgery, and robotic hernia repair. The surgeon helps to identify whether surgery is necessary and, if so, recommends the best method that suits the patient.
Here, different methods used in hernia repair, preparation for surgery, and aftercare are discussed.
Open hernia surgery
An incision is made at the site of the hernia, the bulging tissue is pushed back into place, a synthetic mesh is placed at the site if there are defective or weak abdominal muscles to help support them, and, then, the incision is sutured back together.
Laparoscopic hernia surgery
The laparoscopic repair operation resembles open hernia surgery, except that tiny incisions are made instead of a single cut as in open hernia repair to the outside of the abdomen or groin to allow surgical tools to be inserted. A laparoscope (a thin, telescope-like instrument) is inserted through one of the small incisions to visualise the hernia and its adjacent tissues.
Carbon dioxide gas is inflated into the stomach to create space and help visualise the internal structures. Further to this, the inner stomach lining called the peritoneum is cut to expose the weakened abdominal muscles, and then, a mesh is placed to support that weakened tissue. Finally, the incision is sutured closed.
The advantages of laparoscopic surgical treatment include three small scar tissues instead of one larger incision, minimal pain after surgery, a fast return to daily life, and a shortened recovery period.
Robotic hernia surgery
Robotic surgery is very similar to laparoscopic surgery, where a laparoscope is used to visualise the inner structure. In addition to this, robotic surgery is carried out using a console from which the surgeon handles the surgical instruments. It is used to repair small hernias and may be employed in abdominal wall reconstruction.
One of the most significant distinctions between laparoscopic and robotic surgery is that the robot provides good three-dimensional pictures of the interior of the stomach as compared to the two-dimensional pictures of laparoscopic surgery. Robot-assisted surgery also lets surgeons easily stitch tissue and place meshes inside the abdomen by using stitches.
Before the hernia repair surgery
- The patient may be advised to undergo pre-operative physical examinations and investigations, including blood tests, imaging tests, an electrocardiogram (EKG), and any other tests that may be necessary to assess if the individual is healthy enough to undergo the anaesthetic procedure.
- The surgeon might recommend that the patient refrains from taking aspirin or other medicines that may raise the likelihood of bleeding one week prior to the hernia repair.
- One night prior to the surgery, the patient will be instructed not to consume any food or beverages (except medicines). This reduces the possibility of throwing up during surgery.
- On the day of surgery, the surgeon may instruct the patient to take specific medications only with a small amount of water.
- The patient will be advised to have a sound sleep the night before the surgery.
Day of hernia repair surgery
- The patient must arrive at the hospital well before surgery time.
- The patient will have to sign a consent form. The patient should read the form carefully before signing it.
- The patient will be asked to change their clothes, remove their jewellery, and wear a hospital gown.
- Any pre-operative medicines will be given as needed, and vital signs will be monitored and documented.
- A nurse would then place an IV catheter into the patient’s hand or forearm before administering general anaesthesia.
- The patient will then be taken to the operating room for the procedure.
After the hernia surgery
- The patient will be transferred to a recovery room after the surgery. The vital signs (blood pressure, heart rate, respiratory rate, and urine output) will be continuously monitored.
- If the patient has nausea, vomiting, or is unable to pass urine after anaesthesia, they may have to be kept in the hospital for that night.
- If the patient receives general anaesthesia, their coordination and reasoning may be impaired for a short time. As a result, the patient must refrain from driving, drinking alcohol, and making important decisions for at least 48 hours following surgery.
- Following the operation, the site of the surgery will be sore and uncomfortable. The patient will be given pain relievers to help with the discomfort.
- The patient will be sent home from the hospital only when their condition has stabilised.
After-hospital/at-home recovery process
- Each of the doctor’s instructions must be followed at home.
- To avoid clot formation, the patient must gradually increase their levels of activity.
- For 4 to 6 weeks, patients should avoid strenuous activities and heavy weightlifting.
- To avoid constipation, patients should adhere to a high-fibre diet and consume plenty of fluids. If the patient strains during bowel motions, constipation may cause discomfort around the wound.
- Patients should avoid wearing snug-fitting clothes, as wearing clothes that are too tight can irritate the incision wound and slow the healing process.
- The patient should wash their hands prior to and following touching the incision site to avoid developing an infection.
- When it involves changing the bandages, the patient should stick to the surgeon’s instructions.
Initial follow-up appointment
- The first follow-up consultation with the doctor after the surgery is usually scheduled within two weeks of the surgery.
- During this follow-up, the doctor will perform a thorough examination of the surgical site to assess the recovery process.
- According to the condition and healing of the surgical site, the doctor may also modify the medicines or suggest that the patient keep going with the earlier medication for some time.
- The doctor will also advise the patient on additional timely follow-ups.
Risks and complications of hernia repair surgery
Hernia repair is a relatively safe procedure. Nonetheless, there is always the possibility of complications. These include:
- Excessive bleeding
- Blood clots
- Injury to the nearby organs and structures, such as the intestine or testicles
- Allergic reactions to anaesthetics, medications, or surgical materials used during surgery
Hernia repair in children is nearly always successful in the long run; however, it is possible that the hernia may return in a small percentage of individuals.
When is a doctor’s consultation required?
If a patient is experiencing one or more of the following symptoms, they should immediately contact a doctor or surgeon:
- Bleeding at the site of the incision
- Smelly discharge from the site of the incision
- Fever, chills, or redness at the incision site
- Painkillers not relieving abdominal swelling or discomfort
- Nausea or vomiting on a regular basis
Hernia surgery cost in India
Several factors influence the cost of a hernia operation, including:
- Availability of an experienced surgeon
- Surgical technique: open, laparoscopic, or robotic
- Mesh repair
- Patient’s health status
- Doctor consultation fees and investigation charges
- Location of the hospital and the facilities
In general, robotic and laparoscopic hernia surgery is more expensive than open hernia repair surgery due to the specialised equipment and instruments used during the procedure. If a synthetic mesh is placed to strengthen the weakened abdominal wall, the cost may be higher as well.
In conclusion, hernia surgery is a commonly performed procedure used to treat different types of hernias. The procedure may be carried out open, laparoscopically, or robot-assisted, and the method used is determined by the type and extent of the hernia.
Although hernia operation is generally regarded as effective and more or less risk free, there are some risks associated with it, including bleeding, infection, and hernia relapse. Patients must follow their healthcare provider’s pre- and post-operative instructions to minimise the likelihood of complications and ensure a quick recovery.
All in all, hernia surgery provides relief from hernia symptoms and improves patients’ quality of life. However, it is critical to consult with a healthcare provider about the benefits and risks of the surgery before arriving at a conclusion about the best possible treatment for each case.