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Friday, July 17, 2009

What is a Hernia ?

[Extracted from Medicine.Net.Com]

What is a hernia ?

A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.

Serious complications from a hernia result from the trapping of tissues in the hernia—a process called incarceration. Trapped tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

Where are hernias located ?

The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force occurring at the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues enlarging any preexisting hole or leads to a tear resulting in a new hole.

Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). This type of hernia is usually painless. Hernias can also occur within the navel (umbilical hernia).

What are the symptoms of a hernia ?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

What other types of hernias are there ?

Epigastric, umbilical, incisional, lumbar, internal, and Spigelian hernias all occur at different sites over the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

How is a hernia repaired ?

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the problems with this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. This has proved to be a very effective means of repair.

After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques

What is laparoscopic hernia repair ?

A number of factors have led to the recent development of a new method of repair called laparoscopic hernia repair. This technique is really an extension of a traditional mesh repair method that was used in patients who had already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.

What about the use of a laser in hernia repair ?

This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laser hernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no application in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. Hopes that somehow an incision made with a laser would significantly reduce pain have not been confirmed.

What kind of anesthesia is used for hernia surgery ?

Most hernia repairs (except in children) can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesia (inducing "sleep") can be very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often at the same time using sedation medications to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.

Can strengthening the muscles make a hernia go away ?

Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.

What can be done to prevent a hernia ?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, and weight-control problems.

Are hernias inherited ?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem.

Do hernias usually develop on both sides of the body ?

Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.

Should all hernias be repaired ?

In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.

Sometimes, a hernia can be temporarily controlled by wearing a belt-like device that applies external compression, which pushes the tissues back into the abdomen and holds them there. This device is called a truss. The truss must be carefully applied on a daily basis. It should only be used for selected situations following careful evaluation by a doctor.

How can I tell if a lump or swelling is a hernia ?

Not all lumps or swellings on the abdominal wall or in the groin are hernias. A doctor should evaluate any such swelling. Other possible causes include growths or enlarged lymph nodes. These problems require entirely different types of evaluation and treatment.

Hernia At A Glance :

* Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

* There are many different types of hernias.

* Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage of death of the tissue.

* Hernia repair and the treatment of hernia complications require surgery.

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