1. The hernia sac is incised;
2. The incomplete hernia is pushed into the physiological body cavity;
3. Herniotomy is performed by suturing the herniated collar and sac either completely or to the physiological size. 

In some cases, it may be necessary to apply additional reinforcing materials to the herniotomy gate. Usually, this role is played by various meshes or plates that are fixed to the surrounding tissues and prevent organs from escaping further into the hernia sac. Such strengthening of the herniotomy gate also significantly prevents the development of recurrences. 

Possible complications

As a rule, operations on most hernias occur without much difficulty. If a complicated hernia is operated on, the surgeon may encounter the following complications:

• Abscess;
• Perforation of organs (often intestines) that are in the hernia sac;
• Peritonitis;
• Coprostasis;
• Presence of adhesions between the hernia and the hernia sac.

Among the most likely complications that often occur in those who have had surgery to remove a hernia is a hernial recurrence. In order to avoid a recurrence, it is advisable to strictly follow the doctor’s orders and try to eliminate the factors that led to their development (e.g. obesity). It is also important to note the possibility of adhesions.

Outlook

In general, the prognosis for the life and health of a patient who has undergone hernia surgery is positive. To prevent hernia recurrence and the occurrence of adhesions can only be prevented by full compliance with all measures, a list of which will be provided to you by your doctor after surgery.

 

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What is a hernia?

A hernia is a condition in which organs move out of their normal position. Physiologically they are located in cavities, but may move due to physiological features of the body or form as a result of pathological openings in the human body. It is important to note that when a hernia is formed, the organs are not damaged and retain the integrity of all their membranes and tissues. The hernia itself consists of three key components:

• The hernia sac. The cavity that houses the organs that form the hernia. 
• The hernia gate. The very opening through which the organs enter the hernia sac.
• The contained of the hernia. All the organs that fill the sac.

Varieties of hernias

Depending on the anatomy, there are many different types of hernia. It would take more than one page to list all the types of hernia that exist in terms of anatomy, so we will limit ourselves to stating that they are internal (accounting for about 25% of all cases) and external (up to 75%). Normally, external hernias can be seen with the naked eye on the surface of the human body. However, there are exceptions to this rule. One of the most important classifications of hernias is as follows:

• Fully reparable (the hernia can be repaired by pressing with the fingers or other techniques);
• Partially reparable (only a certain part of the hernia can be repositioned to a physiological position);
• Non-rectifiable (the hernia cannot be repaired using traditional techniques).

However, the detection of a hernia is not yet a mandatory indication for gerinoplasty (hernia operation). The clinically important classification is the one that allows one to judge the extent of their impingement. According to this classification, the following are distinguished:

• Unruptured hernias (often reparable, but not always. The organs in such hernias function normally and the quality of life of a person with such a hernia may not be affected at all.)
• Strangulated hernia (usually does not present. Organs are not compromised and cannot perform their function normally).
• Compound hernias. (May be complicated by phlegmon, coprostasis, peritonitis, etc.).

Generally, the indication for emergency hernia surgery is the detection of a hernia that is impinged or complicated. It is important to remember that an uncomplicated hernia can develop into a strangulated hernia over time. Therefore, if any hernia is identified, it is necessary to see a surgeon for further consultation. 

What causes them?

In older age, hernias often occur when the pressure on the organs outside the herniation gate is much greater than the pressure on the other side. As a result, organs take the path of least resistance and gradually pass through the hernia gate, forming a hernia sac. Here are the main causes that contribute to the formation of hernias:

• Obesity;
• Developmental abnormalities;
• Connective tissue abnormalities;
• Lack of exercise;
• Previous surgical interventions.

Some hernias may be congenital. Often they are diagnosed and removed in childhood. These may include oblique inguinal hernia in infant boys. They constitute a fairly small percentage of all diseases of this type and are mainly treated by traditional herniotomy. 

Hernia symptoms

The main symptom of a hernia is a bulge on the surface of the body which may or may not be repositioned, depending on the nature of the hernia. Many novice surgeons as well as patients who encounter it for the first time may misdiagnose the bulge. That is why it is advisable to consult an experienced specialist at the slightest suspicion of a hernia.

The occurrence or intensification of pain, an increase in the size of the bulge, a feeling of pressure, or the appearance of sharp pain when coughing, exercising or running also indicate the presence of a hernia. On the other hand, there are kinds of hernias that cannot be diagnosed without specialised tests. 

Hernia diagnosis

When an external hernia is diagnosed, in most cases a surgeon only has to talk to the patient and then examine the site of the bulge on the patient’s body. Sometimes the patient may be asked to cough, squat or bend over to observe the bulge’s reaction. In most cases, it should enlarge.

Diagnosing internal hernias is a more complex task and may often require additional methods of examination. Among the most popular are contrasting x-rays, magnetic resonance imaging and computed tomography.  

Hernia treatment

The method of hernia treatment depends on whether the hernia is complicated or not. In patients with complications, surgery may be necessary to make anastomoses (artificial connections between organs) and remove part or all of the organs involved. These operations are usually performed on impinged or severely compromised hernias.

So-called hernioplasty is often performed to treat uncompartmentalised hernias. Some operations on internal hernias can be done laparoscopically. External hernias are operated using the open method. The operation is carried out as follows: 

1. The hernia sac is incised;
2. The incomplete hernia is pushed into the physiological body cavity;
3. Herniotomy is performed by suturing the herniated collar and sac either completely or to the physiological size. 

In some cases, it may be necessary to apply additional reinforcing materials to the herniotomy gate. Usually, this role is played by various meshes or plates that are fixed to the surrounding tissues and prevent organs from escaping further into the hernia sac. Such strengthening of the herniotomy gate also significantly prevents the development of recurrences. 

Possible complications

As a rule, operations on most hernias occur without much difficulty. If a complicated hernia is operated on, the surgeon may encounter the following complications:

• Abscess;
• Perforation of organs (often intestines) that are in the hernia sac;
• Peritonitis;
• Coprostasis;
• Presence of adhesions between the hernia and the hernia sac.

Among the most likely complications that often occur in those who have had surgery to remove a hernia is a hernial recurrence. In order to avoid a recurrence, it is advisable to strictly follow the doctor’s orders and try to eliminate the factors that led to their development (e.g. obesity). It is also important to note the possibility of adhesions.

Outlook

In general, the prognosis for the life and health of a patient who has undergone hernia surgery is positive. To prevent hernia recurrence and the occurrence of adhesions can only be prevented by full compliance with all measures, a list of which will be provided to you by your doctor after surgery.

 

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