Treatment of a hernia

Symptoms of a hernia vary depending on its type. In some cases, there may be no symptoms at all.

For inguinal, femoral, umbilical, and incisional hernias, symptoms may include:

• A visible bulge under the skin of the abdomen or groin, which may be painful and may disappear when lying down

• A feeling of heaviness or pressure in the abdomen, sometimes accompanied by constipation or blood in the stool

• Abdominal or groin discomfort when lifting or bending over

• A burning sensation or pain in the bulge

• Weakness or pressure in the groin

• Heartburn

• Difficulty swallowing

• Sharp or shooting pain

• Nausea or vomiting

• Constipation

• Pain and swelling around the testicles

Symptoms of a hiatal hernia (hiatus hernia) may include heartburn and pain in the upper abdomen.

Hernias usually do not go away on their own, and surgery is often the only way to fix them. Your surgeon will discuss with you the method of repair that best suits your needs.

Hernia removal surgery can be performed using one of three methods:

1. Open (traditional) method. The surgeon repositions the hernia and, if there is intestinal compression, removes the part of the organ that was not receiving oxygen. The damaged muscle wall is often repaired with a special surgical mesh or tissue. Open access involves a 4 cm incision through which the mesh is fixed. This access allows the surgeon to have a good view during the operation. The surgeon hides the scar in the navel. Inguinal hernia surgery is most often performed under local anesthesia. Spinal anesthesia is not recommended [2].
2. Laparoscopic method. Increasingly, herniorrhaphy is performed using a laparoscope, a thin instrument that requires smaller incisions and provides a shorter recovery period and less postoperative pain. However, the total length of the incisions with laparoscopy can exceed the length of the scar with open access. Disadvantages also include: general anesthesia, in which the abdomen is filled with carbon dioxide, which leads to less reliable fixation of the mesh and possible recurrence. A laparoscopic approach may be considered if the hernia defect is large or the patient is at increased risk of developing wound complications [3].
3. Preperitoneal access is performed using the same technical means as laparoscopic through punctures. Disadvantages: lack of fixation of the mesh, which leads to its unwanted movement over time; this access takes longer to perform; increased risk of damage to the organs from which the hernia formed.

List of used literature:

1. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165.
2. Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M; Danish Hernia Database. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull. 2011 Feb;58(2):C4243 .
3. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP; European and American Hernia Societies (EHS and AHS). Guidelines for the treatment of umbilical and epigastric hernias from the European Hernia Society and the Americas Hernia Society. Br J Surg. 2020 Feb;107(3):171-1