Mr Charles Imber offers expert abdominal surgery. The operations that he performs can treat a variety of conditions that affect the organs inside the abdomen (pancreas, gallbladder, liver, spleen, small and large intestine) or the abdominal wall (hernias).
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When an abdominal hernia first appears, it is usually just a small lump either on the front of the abdomen or lower down in the groin. Hernias can be treated effectively, so it makes sense not to ignore them. With time they get bigger and can cause complications.
A hernia needs to be assessed by a GP or a specialist in hernia surgery. Most hernias in adults need surgical hernia repair. Today, this is either done using a keyhole technique or a more traditional open operation. Laparoscopic hernia repair is a day-case operation and recovery time can be faster than with the traditional open hernia surgery repair technique.
The commonest thing to notice is a pain in the groin or a small lump. It is often more noticeable with an increase in intra-abdominal pressure such as when coughing, sneezing or straining. If the hernia suddenly becomes more painful or larger urgent medical advice is required as this can suggest strangulation, these are the normal Hernia symptoms.
What is an abdominal hernia?
The lump that appears if you have a hernia is a portion of your intestine poking through a weakness in the body wall. A weak spot can appear anywhere and is due to separation or tearing of the sheet of muscle that protects the abdominal organs. The lump usually goes back in when gentle pressure is applied – that’s a reducible hernia. Sometimes hernias don’t go back into the abdomen at all – that’s a non-reducible hernia.
What causes a hernia?
Hernias have many different causes but lifestyle plays an important part. You are more likely to develop a hernia if you are:
- Overweight or obese
- Often constipated
- A smoker and you have a smoker’s cough
- A woman who has had several pregnancies
- A manual worker who often has to do heavy lifting.
Common types of abdominal hernia
The basic underlying cause of any hernia is the same but different types of hernia are recognised according to where they occur and what triggers them.
Inguinal hernias: These develop along a line of weakness through the muscle in the groin. This channel is the inguinal canal and a hernia here is more likely in men as the tubes that run from the testicles pass near here. About three-quarters of all hernias are inguinal and in every 100 people diagnosed with an inguinal hernia, 96 will be men and only four will be women.
Femoral hernias: These also arise in the groin but are generally rare. They are more likely to develop in women than men and are also more prone to complications.
Umbilical hernias: These develop at weak points in the muscle underlying the umbilicus – the belly button. This type of hernia can develop in babies shortly after birth but usually get better on their own. Adults can also get them, but need treatment as they tend to get worse over time.
Midline hernias: This term is used to describe a hernia on the front part of the abdomen that is not associated with the belly button.
Incisional hernias: Whenever the body wall is cut, such as if you have had an open appendix operation or a Caesarean section during childbirth, the healed scar is never as strong as the original body wall. Hernias are common along incision lines and can be one of the most difficult hernias to repair.
An untreated hernia carries a significant risk that it will become a strangulated hernia. When the intestine pokes through the body wall, there is a danger that it will swell, become stuck and then become more inflamed. As the pressure on the exposed intestine builds, its blood supply is reduced and eventually cut off. The intestine begins to die, it may rupture and there is a danger that the contents of the intestine will contaminate the peritoneum, the inner cavity of the abdomen. Peritonitis is a severe infection that can spread throughout the body causing sepsis, which can kill.
A strangulated hernia, a large hernia or a complex incisional hernia need more than routine hernia repair and are best treated by an expert surgeon with experience of treating complex hernias. In some cases, reconstructive surgery as well as hernia repair with different types of hernia mesh will be necessary.
Hernias that come back
Once a hernia has been repaired, whether by laparoscopic surgery or in an open repair operation, it may never recur. In some people, however, hernias do come back, either in the same place or in another part of the abdomen. Separate new hernias can often be repaired in a second routine operation but recurrent hernias that develop in the same site need expert surgery to deal effectively with hernia repair failure.
- A lump in the abdomen or groin. It can be associated with the belly button or with a scar from a previous operation.
- Soreness around the lump: this may be the first sign of a strangulated hernia, which needs emergency care.
- Hernias are diagnosed by taking your medical history and examining the lump. No imaging tests or other diagnostic tests are usually required.
- Laparoscopic hernia repair using a surgical mesh.
- Open hernia repair using a surgical mesh.
- Reconstructive surgery after complex hernia repair.