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Definition
A hernia literally means that the intestine escapes through the weakened abdominal wall, and when a hole in the abdominal wall or other parts of the human body is created due to congenital or acquired causes and the pressure in the abdominal cavity rises, an organ or tissue comes out through this gap.
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Self-Diagnosis
01
When standing or exercising, both groin, navel, or wounds of previous surgeries come out convexly.
02
There is something palpable like a lump between the groin and thigh.
03
When you cry or cough hard, it comes out bulging.
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It disappears when you push it by hand or lie down.
Do I need to have hernia surgery?
1. A hernia that has fallen out does not return on its own, so it is necessary to have surgery at an early stage so that the wound is small and the recovery is quick.
2. If an inguinal hernia is left untreated for too long, the prolapsed hernia suddenly swells and remains protruding, and necrosis or entrapment in the intestine may result in emergency surgery that requires excision of the intestine. Therefore, it is recommended to operate as soon as possible.
Occurrence Rate
· It occurs in 2-3% of the population, of which inguinal hernias account for 75%. Inguinal hernia in children occurs in 1-2% of normal infants and 5-10% of premature infants. Male:Female = 4:1, more common in males.
· Inguinal hernia, which accounts for 75% of all hernias, occurs in the groin 2-3 cm above the area where the thigh meets the lower abdomen, and the hernia sac often descends to the testicle.
· Although hernias are more common in men over the age of 40, they are not exclusively male diseases. They can occur to anyone of any age.
· In addition, the incidence rate of inguinal hernia on the right side is twice that of the left side, and the incidence rate is increasing due to the recent increase in the elderly population.
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Types
Hernias can be classified according to their location within the abdominal wall or a specific cause.
· Inguinal hernia
The area between the thigh and lower abdomen is called the groin, and there are two types of inguinal hernia: indirect hernia and direct hernia. - Indirect hernia : occurs deep in the inguinal canal, exits through the hernial sac, and often descends to the testicles. It accounts for more than 80% of inguinal hernias. - Direct hernia : The lower part of the inguinal canal is weakened and protrudes forward.
· Femoral hernia
Femoral hernias are a form of direct inguinal hernia and occur slightly below the inguinal hernia, that is, under the abdominal crease. Compared to inguinal hernias, the risk of incarceration is higher and tends to occur more frequently in women.
· Incisional hernia
An incisional hernia is a hernia that occurs when the surgical site becomes weak and widens. Because it is known as a hernia that tends to recur after surgery, you need to be very careful during surgery.
· Umbilical hernia
It refers to a hernia that occurs through a weakened area in the umbilicus, and is usually congenital in newborns. Usually, it disappears on its own before the age of 2, so if it does not go away after age 2, then an umbilical hernia with a diameter of 2 cm or more requires surgery.
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Risk Factors
· Congenital causes
Hernias that occur in children are almost congenital, and indirect inguinal hernia, which accounts for more than 80% of inguinal hernias, is not caused by a gap in the abdominal wall, but rather because the peritoneal sac formed in the fetus was open or weakly blocked and then opened again, and the intestine is pushed through this gap.
· Acquired causes
Acquired causes include severe exercise that can increase abdominal pressure, constipation, pregnancy, ascites, chronic cough, etc. Also, aging that can weaken the abdominal wall, chronic diseases such as diabetes, heart disease, previous abdominal wall damage or surgical incision may cause hernias.
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Complications
· Incarceration
It is a condition in which the intestine is caught in the hernia cavity and cannot return to its original position in the abdominal cavity, and the blood circulation of the hernia organ is disturbed, causing severe pain.
· Strangulation
It is a very dangerous complication when the blood circulation in the intestine or organs is blocked and necrosis occurs, due to the prolonged incarceration.
· Emergency measures for incarcerated pediatric hernia
1. Lay the child down in a comfortable position, let him relax, and if he cries, help him stop. 2. If he falls asleep comfortably without pain, most of the time, it will go in on its own, so wait for 1 or 2 hours. 3. If he continues to complain of the pain, do not press the prolapsed hernia or forcefully insert it, but use your fingers to stretch the convex area like stretching a rubber band. 4. If the hernia does not enter even after repeating the process several times and the pain continues, it is recommended to visit the hospital as soon as possible.
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Surgical Methods
Most hernias can be cured relatively easily with surgery, and surgery is the only treatment method. Recently, there have been epoch-making developments in surgical methods, and instead of using only one or two methods, the surgical methods suitable for the patient can be selectively performed in various combinations according to the characteristics and conditions of each patient.
· High Ligation of Hernia Sac
It is a process of separating the hernia sac from the surrounding tissue, partially excising it, and putting it back in its original position. It is the first step of all hernia surgeries except laparoscopic surgery. For surgeries to treat pediatric inguinal hernia surgery, this is their last stage.
· Herniorrhaphy
This is a surgical method in which the surrounding muscles are pulled and sutured to reinforce the weakened abdominal wall after high ligation. It can result in excessive tension around the muscles, and this tension may cause pain after surgery, which may delay recovery. Not only that, but since the stitched parts are pulled apart by tension, the tissue may weaken and cause hernia to recur.
· Hernioplasty
01) Lichtenstein Repair
After completing the above step 1 (high ligation), the muscle layer covering the peritoneum is covered with a tension-free artificial membrane (mesh) and sewn. In other words, instead of pulling and sewing the surrounding muscles to strengthen the surgical site, it covers the part with an artificial membrane. This repairing method using the tension-free mesh is the most popular surgical method recently, because it causes less postoperative pain, guarantees a quick return to daily life and reduces recurrence rates.
02) Mesh Plug Repair
This is a method to block the hole in which the hernia came out by inserting a plug made of a cone-shaped artificial membrane and fixing it. It is a method that has been widely practiced in the United States since the 1990s. It is a relatively simple procedure, easy and fast, and there is no pain after the operation.
· laparoscopic surgery
Although it is laparoscopic, it also uses an artificial membrane to block the hernia and reinforce the abdominal wall. Therefore, laparoscopic hernia surgery can also be included in the category of tension-free artificial membrane repair. The difference from Lichtenstein Repair is that the method involves use of a laparoscope and the position of the artificial membrane. In Lichtenstein Repair, the artificial membrane is placed outside the muscle layer, whereas in laparoscopic surgery, the artificial membrane is placed inside the muscle layer or into the peritoneum.
