Marlex® Mesh HERNIA
OPERATION
What is a hernia?
A hernia is a lump caused by weakness in the front wall or lining of the
abdomen (the area covered by the midriff or tummy). It is a very common
condition which can affect men, women or children at any age.
A hernia is just like a ruptured tyre. When the tyre wall separates the
inner tube can push through the opening. When a hernia develops in the
abdominal wall, the abdominal lining can push through, creating a sac. Tissue
such as part of the bowel can drop into this sac, causing a lump in the groin.
This lump is more noticeable standing up. Lying down allows the tissue in
the sac to go back to its normal position and the lump will temporarily
disappear.
What causes a hernia?
Hernias commonly occur in the groin area because of inborn weaknesses in
the wall of the abdomen. These weaknesses are due to blood vessels and other
tissue passing through gaps in the abdominal wall. If these gaps are widened,
they allow the inner lining of the abdomen to push through the wall and form a
hernia.
Hernias can be caused by the abdominal wall being weak from birth and these
often appear on both sides of the groin (1) In other
people, the weakness in the wall may only appear in later life because it takes
time for the sac to enlarge enough for tissue to drop into it.
The wall may weaken over time due to stress and strain, or in other cases be
put under sudden pressure from heavy lifting, sport or coughing. Overweight
people may develop a hernia.
What happens when you have a hernia?
The hernia forms in the weakened abdominal wall. At the weak spot, the
hernia sac or bulge may fill with part of the intestines, fat or other tissue.
This often causes some pain. If left untreated, hernias can cause serious
intestinal problems. When a hernia first develops, you may not be able to see
the bulge but you may feel burning or tingling in the groin. You may feel some
pain when straining through lifting, coughing or passing urine.
If you have developed a bulge but it disappears when you lie down or push
against it, this is called a reducible hernia. You are not in immediate danger,
but you probably need hernia repair and should consult your GP.
If the intestine gets trapped, you won't be able to make the bulge
disappear. You have a non-reducible hernia. This is often painful and you need
prompt surgery and should see a doctor as soon as possible.
If the intestine is tightly trapped, you have a strangulated hernia. The
blood supply is cut off and the intestine can die. This can also prevent
digestion and cause severe pain. You need emergency surgery to remove the
blockage and repair the hernia. You must consult a doctor immediately.
What type of hernia do I have?
Doctors give different names to hernias depending on where they are in the
body and how serious the bulge has become. Most hernias occur in what is known
as the inguinal region, which is that soft part of the body below the navel and
just above each hip joint, commonly known as the groin.
An indirect inguinal hernia is the most common type. In men, this is due to
a weakness in the part of the body where the testicles pass down from the body
into the scrotum. This area is known as the internal ring. In women, a hernia
can develop in the same area and can extend to the outer folds of the genitals.
A direct inguinal hernia is more common in men over the age of 40. This is
due to a weakness in the groin area near the internal ring, caused by ageing or
injury.
Femoral hernias are more common in women and are caused by a weakness below
the groin and high up in the thigh. They are often small but will not push back
and can cause serious complications.
An incisional hernia is caused by weakened scars from previous surgery, or
by abdominal pressure due to overweight or heavy coughing.
An umbilical hernia looks like a bulging navel. It can be caused by a
weakness at birth, or one developed over time. They are sometimes due to
abdominal pressure from overweight, heavy coughing or pregnancy.
The most common types of hernias in children are umbilical and indirect
inguinal hernias. Umbilical hernias may get better on their own, but an
indirect hernia will usually need repairing.
What should I do about my hernia?
Only your doctor can tell if you do have a hernia. Once you have a hernia, it
will not go away on its own. Some people wear a truss, but doctors now know
that this will not reduce the pain or stop serious complications developing. It
is better to have your hernia repaired before it gets bigger and more
complicated. How can I get my hernia repaired?
If you think you have a hernia, you should see your doctor as soon as
possible so that you can be accurately diagnosed. You and your doctor can
decide together when your hernia should be repaired.
What sort of hernia repair should I have?
Some surgeons still use traditional methods of repair which involve pulling
together the muscles and ligaments and stitching them in place. These repairs
are often painful because of the strain caused by pulling the tissue into place
and this same tension can cause the repair to separate in time. One in ten
hernias repaired in this way come back again.(2)
Some surgeons use the Canadian (also known as the Shouldice) technique,
which involves stitching through three overlapped layers rather than one, as in
the traditional method. In expert hands, this technique can be performed as a
day case and the hernia rarely recurs.(2,3)
An increasing number of doctors now prefer the new tension-free mesh hernia
repair.
What is tension-free mesh hernia repair?
Tension-free mesh repair does not pull the muscles and ligaments together.
It involves placing a piece of strong polypropylene mesh over the weakened
abdominal wall. The body tissue then grows through the mesh, combining with it
to form a strong and permanent repair.
The hernia rarely comes back. Many people can have a tension-free mesh
repair under local anaesthetic as day case patients.
This means they may be able to go home within a few hours of the operation.
If you do have to stay in hospital with a tension- free mesh repair, it will
usually be for just one or two days.
There is much less pain after a tension-free mesh repair and you will
usually be given a mild painkiller. A tension-free repair does not involve as
many restrictions on activity as the traditional methods. Many people resume an
active life soon after the operation.
When you have a hernia an opening exists that must be closed.
Traditional hernia repair pulls muscles and ligaments together to close the
opening, which creates tension.
"Tension Free" hernia repair places a strong mesh over the opening
for reliable reinforcement, without creating tension or distorting normal
anatomy.
References
1. Hernia Repair Operation. Questions and
Answers. The Royal College of Surgeons of England, 1993.
2. Guidelines on the management of
groin hernia in adults. Report of a working party convened by the Royal College
of Surgeons of England, 1993.
3. Prospective randomised trial
comparing the shouldice technique and plication darn for 300 inguinal hernias:
a two year minimum follow-up. British Journal of Surgery, 1992; 79:
1068-70
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