Hernia

There are several types of hernias, the most common of which are:

• Inguinal hernia - Accounting for around 70% of all hernias, inguinal hernias occur when the intestine or bladder protrudes through the lower abdominal wall or the inguinal canal in the groin, which houses the spermatic cord that supports the testicles (men) and the ligament that keeps the uterus in place (women). This type is more common in men than women.
• Hiatal hernia - This occurs when the upper part of the stomach juts out of the abdominal cavity through the esophageal hiatus, an opening in the diaphragm that holds the esophagus and vagus nerve.
• Umbilical hernia - Common in newborns and babies under 6 months, umbilical hernias develop when part of the small intestine squeezes out of the abdominal wall near the navel (belly button). It is harmless and typically goes away on its own by the time the child reaches one year old.
• Femoral hernia - Similar to inguinal hernias, femoral hernias occur in the groin, but these more commonly affect women, especially those who are pregnant or obese. This type of hernia happens when the intestine pushes out of the lower abdominal wall and into the femoral canal in the upper thigh.
• Incisional hernia - This occurs when the intestine protrudes out of the abdominal wall via a previous incision or weakened tissues and muscles in an old surgical site.

The most common sign of a hernia is a noticeable bulge or swelling in the affected area. This may be accompanied by pain or discomfort, especially when lifting heavy objects, bending over or straining during bowel movements. In some cases, hernias can also lead to symptoms such as nausea and vomiting.

If left untreated, a hernia can lead to serious complications, including:

• Bowel obstruction: The herniated tissue may become trapped, blocking the intestines and causing pain, nausea or vomiting.
• Strangulation: If blood flow to the trapped tissue is cut off, the tissue can die, leading to a life-threatening emergency requiring immediate surgery.

Early medical evaluation and management are crucial to prevent these potentially severe outcomes.

If you suspect that you may have a hernia, it is important to consult a hernia doctor for an accurate diagnosis and appropriate treatment. Doctors typically use the following methods to diagnose hernias:

• Physical examination: A thorough physical exam is often the first step. Your doctor will check for any visible or palpable bulges, particularly when you stand, cough or strain.
• Imaging tests: To confirm the diagnosis and assess the hernia more clearly, your doctor may order imaging studies such as an ultrasound, CT scan or MRI.
• Specialised tests: In certain cases, additional investigations may be necessary to determine the hernia’s exact size, location or complications. Tests such as a herniogram or diagnostic laparoscopy may be used to provide more detailed information before deciding on the most suitable treatment approach.

Hernias may be painless and asymptomatic or may only cause mild to moderate discomfort. However, apart from umbilical hernias, most types of hernias do not go away on their own, and left untreated, can lead to serious complications. As such, hernia surgery may be needed.

There are two types of hernia surgery:

• Herniorrhaphy (Tissue Repair)Traditionally performed via open surgery, herniorrhaphy involves creating an incision over the site of the hernia. The displaced organ is manually placed back to its normal position, and the opening from which the organ protruded is stitched closed. The initial incision is also sutured and applied with dressings to facilitate healing. Herniorrhaphy may be done laparoscopically.
• Hernioplasty (Mesh Repair)For larger hernias where the displaced organ cannot be pushed back through the cavity, the hernial sac may be repaired by covering it with a surgical mesh. This process, called hernioplasty, stitches a mesh patch made of animal tissue or polypropylene over the cavity. This patch will then be used by the damaged or weakened tissues and muscles as a support during regrowth. Similar to herniorrhaphy, hernioplasty can be performed via laparoscopic surgery.

Hernia repair surgery is typically performed under general anaesthesia, meaning you will be asleep and pain-free throughout the procedure. The surgical approach depends on the type, size and location of the hernia, as well as the patient’s overall health.

• Surgical procedure: Once anaesthesia takes effect, the Singapore hernia specialist will make an incision near the affected area. The herniated tissue is gently pushed back into its proper position within the abdominal cavity.
• Repair of the muscle wall: The weakened or torn muscle wall is then reinforced using stitches, surgical staples or medical adhesive. In many cases, a synthetic mesh is placed over or under the repair site to provide additional support and reduce the risk of recurrence.
• Laparoscopic option: Some hernias may be repaired using minimally invasive laparoscopic techniques, involving several small incisions and the use of a camera and specialised instruments. This method often results in faster recovery and less postoperative discomfort.

Overall, hernia surgery is a common and safe procedure with a high success rate when performed by an experienced hernia surgeon. Your doctor will choose the most appropriate surgical method based on your individual condition.

As with most surgical procedures, however, hernia repair comes with possible risks. These include:

• Blood clots
• Pain and swelling
• Mesh-related pain or infection
• Excessive bleeding or infection at the surgical site
• Tissue, nerve or organ damage
• Hernia recurrence
• Seroma or fistula formation
• Haemorrhage at the incision site
• Adverse reaction to sedatives