Dr Phil Lockie  
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Hernia & General Surgery

Hernia

A hernia is an area of weakness or defect in the muscles of the abdominal wall. Internal organs can push through this weakness and become visible as a bulge. In addition, the patient may experience discomfort or pain at this site.

The anatomy of a hernia can be compared to a bulge in the inner tube of a tyre. When the tyre is damaged, the inner tube pushes out and bulges through the opening in the tyre. Similarly, when the inner layer of the abdominal wall is damaged, internal organs push out through this defect.

The commonest area to develop a hernia is in the groin where you can develop either an inguinal or femoral hernia. Hernias in this area are more common as there are natural points of weakness in the abdominal wall through which internal organs can travel.

Another area of natural weakness is at the belly button, where the umbilical cord travelled through the abdominal wall to the placenta. Other areas of potential weakness are the site of previous surgery scars. 15% to 20% of patients who have had major abdominal surgery can go on to develop incisional hernias with time. The risk is even higher if your surgery was complicated by a wound infection.

Most patients experience some mild discomfort at the site of their hernia, particularly if they have been lifting or straining. In most cases this discomfort will settle with rest or by avoiding the activity that causes it. Obviously the defect will not go away and generally tends to increase in size with time but this is over a period of months and years. If you are engaged in heavy manual labour or vigorous physical activity, it is likely that the hernia will get bigger more rapidly.

Very occasionally, a piece of internal organ such as bowel can get trapped in the hernia and this can progress to bowel obstruction or strangulation. In this situation the blood supply to the piece of bowel can be compromised and if it is not treated urgently, there is a risk of developing peritonitis and other complications. Thankfully, this type of complication is rare but if you development a painful, tender swelling at the site of your hernia, or notice any increasing redness at the site, or you experience a lump with associated crampy abdominal pain and vomiting, you should bring this to the attention of a doctor as soon as possible as this can become a medical emergency.

With this in mind, it is generally recommended that hernias should be fixed. As the risk of obstruction and strangulation has been shown in recent studies to be relatively low, the timing of surgery can be planned around work commitments. Generally we recommend that if the hernia is interfering with your work or lifestyle, you should consider having it repaired.

Obviously laparoscopic repair of hernias is less painful than open surgery and allows you to resume your normal activities earlier than following open surgery. There is also evidence in some cases that the success of laparoscopic or keyhole hernia repair is higher than the more traditional open hernia repair.

As a member of the European Hernia Society, I keep up to date with new hernia techniques and strive to utilise the best possible materials for hernia repair.

Click here for more information about hernia repair using keyhole surgery