The body is no different to any other structure and the seams or joins are always the weakest link. Too tight or too loose and a seam will either not work or will tear. The abdomen is surrounded by numerous muscles to keep the stomach, small intestine, and colon in place, but if one of these organs slips though a weakness or a hole in the muscles, it becomes a hernia. Other parts of the body can also have organ herniation. For example, people often talk about their back having ‘slipped a disc’, which is actually inaccurate as the situation is caused by interior spine material ‘herniating’ out from between the discs. A hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained.
People are normally referring to the abdomen or groin when talking about hernias. As lead London hernia specialist Mr Arjun Shankar explains in his authoritative article, there are many types of these abdominal hernias including hiatal, umbilical, or incisional.
So what are Midline Hernias?
Midline Hernias are hernias that occur in the midline of the abdomen and are the second most common form. Repairs used to involve stitching and sutures, but these have now been replaced by mesh repairs and this has led to significant reductions in recurrence rates. The technological advances for midline hernia meshes allow them to be safely placed within the abdomen directly onto the bowel. This provides the most mechanically strong repair for what are often complex areas of weakness. Latest Expert Advice on Surgery for Hernias.
Arjun Shankar writes about hernias that occur in the midline of the abdomen – these are second in frequency only to groin hernias. Now that sutured repairs have been superseded by mesh there have been significant reductions in recurrence rates. The technological advances for midline hernia meshes allow them to be safely placed directly onto the bowel. These new meshes have a ‘non stick surface’ which makes placement on the bowel safe. The biological mesh is more impervious to infection and eventually becomes incorporated into the patients own normal tissue. Continue Reading »
In an article by London hernia expert Arjun Shankar, “Latest Expert advice on Surgery for Hernias” we find out what a hernia is and how unless treated properly they can recur and cause complications. Surgical expertise and experience is naturally the most important factor to determine whether the operation is successful first time.
If the groin hernia recurs then any subsequent re-repair is far more complex. Once a repair has been performed the anatomy of the groin is permanently changed with dense scarring around the groin structures. This is why it is so important to reduce recurrence rates to the lowest level possible. The scarring found makes identification of the anatomy far more difficult and hence complication rates are far higher. Nerves are more commonly damaged and the risk of injuring the blood supply to the testicle is not insignificant (up to 5% in some series).
This article is important for any patient who finds that they have done themselves an injury as it will inform the choice of treatment.
Laparoscopic or minimal access surgery (MAS) is increasingly popular for groin hernia repair. In MAS hernia repair the principles are very similar to conventional open surgery but with much smaller incisions. The principal advantage of the MAS approach is less pain post operatively (particularly for bilateral groin hernia repairs which may then be done as day cases) and a faster return to normal activities.
The National Institute for Clinical Excellence (NICE) now states that all patients may be offered a MAS groin hernia repair if performed by a suitably qualified surgeon. MAS repair of recurrent groin hernias is especially effective as by approaching the hernia from the back the surgeon avoids the scarring that would be encountered from the front and hence may reduce the complication rate. See Arjun Shankar’s Latest Expert Advice for the Treatment of Hernias for more information.
Leading surgical expert, Mr Arjun Shankar in an article for in Capital Health explains the different types of hernias and the best methods for fixing them. He describes how a hernia is quite simply a ‘hole‘ in the abdominal wall through which the internal organs may protrude. He says: “This results in a lump which is more obvious when the patient stands or coughs. The reason for this is that in these circumstances the pressure inside the abdomen goes up and pushes the hernia contents out through the defect. Hernias can then become ‘strangulated’ when the contents of the hernia are unable to return to their normal place and hence lose their blood supply.”
Over the last 100 years hernia surgery has developed into a speciality in its own right paralleled with huge leaps in technology and expertise.
Diagnosing Hernias
Most hernias are apparent on examination by an experienced clinician although in some circumstances it may be necessary to get a radiological assessment. The radiological techniques used range from simple ultrasound through to MRI and CT. Imaging of this type may be necessary when planning complex abdominal wall reconstructions, when the diagnosis of a hernia is in doubt or in the setting of a recurrent groin hernia (see below).
