Everything within our bodies sits within an enclosed space and most of these spaces, such as the abdominal cavity, are surrounded by muscle. A hernia occurs when an organ such as the bowel starts projecting out through holes in the muscle.
The most common hernias are in the groin, particularly in men. These occur through a natural hole through which the testicle descends to the scrotum. We call it an umbilical hernia if you can feel a lump around the belly button or anywhere around the mid-line of the tummy
Hernias can happen at any time – even in new-born babies. The holes that exist naturally can sometimes get bigger if, for example, our abdominal muscles get lax. You may have had a hernia for a while before you notice it.
Unless a hernia is repaired with surgery it is always going to stay with you. People usually come to me when they notice a lump or when the lump gets tender and painful or uncomfortable. Repairing a hernia before it becomes extremely painful is a straightforward operation with very little risk attached.
When you come in and see me, we’ll have a chat and go through your symptoms. I’ll usually examine you standing up.
If it’s not clearly seen, I’ll ask you to lie down and I might get you to cough or strain so as to bring out the hernia. I’ll feel how big it is and which direction it is migrating to. In most cases, I can diagnose it straightaway.
We’ll reach a decision together on whether to treat it or not. We tend to leave small, simple hernias alone if they aren’t causing any trouble.
Most patients want the hernia repaired surgically straightaway or certainly within a few months. I’ll take you through the pros and cons of operating and the risks involved. You’ll be given an information sheet about your operation and it will generally be done in two to three weeks.
My preference is an open operation under local anaesthetic because you’ll have a more comfortable recovery. You can also have a general anaesthetic
You will come into the hospital as a day patient and be escorted by a member of staff to an anaesthetic room. After receiving your anaesthetic, you’ll be escorted to theatre where I’ll introduce you to the team. If you are having a local anaesthetic this will be injected. We’ll clean the area and check you’re not in pain and then we’ll start. One of us will keep talking to you as we want to make sure you’re relaxed. If it is under a general anaesthesia then you will go to sleep to have the operation.
Open repair surgery is the gold standard. We make a cut directly where the lump is. Once we deepen it through the skin, there’s usually a layer of fat that takes us down to the hernia. We’ll be looking for a sack that looks like a balloon containing fat or bowel and we trace it down to where the hole is. It’s a bit like a mushroom with a small hole and a biggish sack.
The idea is to separate the sack from the surrounding structures and push everything back in through the hole. Then it’s a question of narrowing the hole, usually with a stitch, and putting a nylon mesh in to strengthen the area. This is the best way of doing it because it has the lowest risk of the hernia coming back (below one percent). Before we started using meshes, it was around six percent.
The operation takes about 30 minutes, plus another 15 minutes for a general anaesthetic. We go slightly slower if you have a local anaesthetic because we make sure you are pain-free at every stage. So, it could take up to an hour.
The other option is to do it as keyhole operation ( laparoscopic). This is always under a general anaesthetic. The principles of the operation are the same but it is done via a camera inserted through your belly button. This is used if it is complicated hernia such as a recurrent hernia or a bilateral hernia.
If you have had a local anaesthetic you can go home fairly quickly, take painkillers and go straight to bed.
The only stitches you’ll have are under the skin and they’ll dissolve. The sealed wound will have a waterproof dressing on top, so you can have a shower the next day.
You’ll have pain for about a week or so but we give you plenty of painkillers to take the edge off. We encourage you to get out of bed the following day and return gradually to your normal daily activity in two or three days. The earlier you start moving, the less stiff you’ll be and you will get better quicker.
You can’t drive for a week or until you can do an emergency stop without any pain.
I will see you again at six weeks. Many people find it reassuring that most things will have settled down by then and be back to normal. It’s also good to know that complications are rare but if there are any they can be easily treated.