An abdominal hernia is a weakness or hole in the abdominal muscle wall through which a "hernia sac" containing abdominal contents (e.g. fat or bowel) may protrude causing the appearance of a bulge or swelling under the skin. The sites in the abdominal wall through which hernias most commonly develop are the umbilicus (navel), the inguinal area (groin) and where an incision from previous surgery has been made through the abdominal wall.
There are a several reasons that Dr Girardi would advise repair:
- Incarceration & Obstruction – the possibility of bowel being caught (incarcerated) in the hernia sac and causing an obstruction of the bowel if present as part of the contens within the sac. Without urgent surgical intervention obstruction may eventually lead to strangulation (cutting off the blood supply to the bowel) with resultant death of the involved loop of bowel. Dead gut then may cause peritonitis (infection within the abdominal cavity, a life threatening situation.
- Pain & Discomfort – usually is the result of stretching or pulling on structures in and around the hernia which may occur for example after prolonged periods standing, walking long distances or straining after strenuous activity. For male patients the pain may radiate to the testicle and confuse the symptoms as arising from the scrotum instead of the groin.
- Restricted physical activity & ability to work – hernias may be caused or aggravated by specific activities that involve straining. These types of activities may be part of usual daily activity such as healthy exercise or may form part of an occupational activity such as lifting heavy objects. The act of straining can cause pain or discomfort and reduce the persons ability to perform those activities.
- Progressive enlargement – with repetitive activites involving straining the size of the hernia may increase over time and increase the likelihood of the all of the above complications. Furthermore the larger a hernia becomes the increasing difficulty the repair becomes and the greater the risk of the repair failing leading to a recurrent hernia.
- Aesthetics – a visible bulge or swelling whch may be difficult to conceal may be a source of embarrassment, leading to social withdrawl from friends, family and social gatherings exacerbating isolation and depression.
Types of Hernia
There are many types of hernia which are simply named depending on their location:
- Umbilical – through the navel
- Incisional – through an abdominal scar
- Ventral – through the muscles in the upper abdomen
- Femoral – along the blood vessels in the thigh
- Hiatus – through the oesophageal opening
- Spigelian – lateral to the central abdominal muscles
Laparoscopic Hernia Repair
Dr Girardi offers a laparoscopic approach sensibly to most hernia repairs and performs this surgery regularly both as a planned procedure and also in the emergency situation. Dr Girardi is up-to-date with the latest information and developments in laparoscopic hernia surgery in particular types and quality of mesh used to strengthen the repair. These techniques are utilised wherever possible to reduce the risk of fialure in the repair and recurrence of the hernia.
Mesh & hernia repairs
Surgery is the recommeded approach for the treatment of any symptomatic or large hernia wherever the hernia is located. Various techniques are used to treat hernias and it is recommended that using ‘tension free’ repair method is the most beneficial approach in hernia repair reducing rates of recurrence. Various types of synthetic material called ‘mesh’ are used to cover or reinforce the defect (hole) whilst minimizing the tension on the surgical wound. Mesh also provides support to the weakened abdominal walls preventing recurrence.
There will be growth of new tissue which may replace or be incorporated into the mesh depending on the bioresorbable quality of the mesh and location of the area of being repaired. Dr Girardi attempts to use higher levels of bioresorbability mesh to decrease the level of foreign material left inside patients and therefore rduce complications such as infection of the material.
Risks & Complications
Some of the rare complications that may occur include:
- Bleeding – can very rarely occur in the first 24 hours after surgery and may require a further operation
- Wound infection – can occur 4 or 5 days after surgery in <1% of all patients having hernia surgery. A short course of antibitics is often enough to remedy this complication as well as adherence to strict personal hygiene in and around the umbilicus (navel) and groin areas reduces this from occurring
- Recurrence of Hernia – < 1% of all hernias Dr Girardi has performed have resulted in recurrent hernia. The rate is dependent on the type and location of the hernia and can occur due to the same reasons that resulted in the hernia in the first instance (e.g. obesity, smoking, immunosupression and diabetes) Avoiding heavy lifting or strenuous physical activity for 4 weeks after surgery helps avoid this problem.
- Injury to surrounding structures – is a very uncommon complication in Dr Girardi's experience
- Scar tissue (adhesions) – laparoscopic repair of hernias reduces adhesions inside the abdomen significantly compared to open hernia but does not completely eliminate the scar tissue from developing
- DVT (clots in the leg veins) – again a very rare complication associated with most forms of abdominal surgery that may lead to clot travelling to the lungs (Pulmonary Embolism). Compression devices on the lower legs, early mobilisation and subcutaneous injections of blood thinning medication all help avoid this complication.