Abdominal wall surgery
What is a hernia?
It is an abnormal protrusion of internal organs, usually the intestine, through a weak area of the muscular wall.
Depending on their location, hernias can be:
Inguinal hernia: appears as a protrusion in the groin and may extend into the scrotum. This type is more common in men than in women (ratio 12/1). The frequency increases with age in men, while it remains constant in women after the age of 40. They can appear de novo or in a patient who has already undergone surgery. In the latter case it would be a recurrent inguinal hernia or a reoccurrence of inguinal hernia.
Crural hernia: is also located in the groin, below the inguinal crease. They are usually smaller, harder in consistency and painful. This type is more common in women.
Umbilical hernia. Epigastric hernia: These are very common and, as the name suggests, appear at or above the navel. Their appearance is almost always related to pregnancy or weight gain.
Spiegel's hernia: are those hernias that arise through a defect in the lunate line. Most of these hernias occur below the level of the umbilicus and lateral to it. The hernial orifice is usually small (1-3 cm) and its contents are usually intestine or fat from within the abdomen.
What is eventration?
This is the protrusion of internal organs (stomach, colon, intestine, etc.) through an already healed surgical wound in the abdomen, lodged under a scar. 70 % of eventrations occur during the first year after surgery, especially from the seventh month onwards.
What are the symptoms of a hernia?
In addition to the cosmetic alterations secondary to the protrusion or "bulge", which may increase in size on exertion, the patient may experience continuous or intermittent pain. In some cases the hernia may disappear spontaneously or with pressure. This does not mean healing, but simply that it has reduced temporarily. It is not uncommon for the patient to experience a feeling of nauseous central abdominal discomfort on exertion. In cases of inguinal hernia, 77 % of patients have no or little pain, 20 % some pain and 3 % severe discomfort.
An incarcerated hernia is simply an irreducible hernia when a short time before it could be irreducible (part of the intestinal contents have passed through the hernial orifice and are retained there). An incarcerated hernia may be strangulated in which case it becomes very painful and the intestinal or fatty contents of the hernia may be compromised. It is considered a surgical emergency because, if emergency care is delayed, bowel resection may be necessary. In the latter case, the patient notices sudden abdominal pain and hardening of the hernia, usually after exertion, which may be accompanied by vomiting and constipation.
How is a hernia or eventration diagnosed?
If you suspect you have a hernia or eventration, you should see your surgeon, who will be able to diagnose it in 95 % of cases with a manual examination accompanied by a simple effort manoeuvre by the patient. In the case of eventration, its diagnosis is simplified, as it presents a previous scar in which a ring-like defect in the abdominal wall can be palpated, or protrusion may occur. In very few cases and in situations of doubt, it may be necessary to perform an abdominal ultrasound scan, a completely painless test, in which the radiologist will try to measure the size of the hernia orifice and the characteristics of its contents. For eventrations and midline hernias, it may be necessary to perform an abdominal CT scan to assess the size of the hernial ring, the volume of viscera inside it and the existence of hidden rings. An incarcerated hernia is simply an irreducible hernia when a short time before it could be irreducible (part of the intestinal contents have exited through the hernial orifice and are retained there). An incarcerated hernia may be strangulated in which case it becomes very painful and the intestinal or fatty contents of the hernia may be compromised. It is considered a surgical emergency because, if emergency care is delayed, bowel resection may be necessary. In the latter case, the patient notices sudden abdominal pain and hardening of the hernia, usually after exertion, which may be accompanied by vomiting and constipation.
When should I have hernia or eventration surgery?
The answer is always, if the patient's general conditions allow it. Hernias account for 60 % of all absences from work due to surgical pathology during a person's working life. The discomfort and pain force the patient to avoid exertion, with the risk of the hernia increasing in size or suffering an episode of strangulation. Sometimes an untreated hernia or eventration, left to its own devices, can grow over the years to reach an excessively large size that makes it difficult or impossible to repair. The use of trusses should not be considered an alternative treatment to surgical repair, as in addition to the discomfort derived from their use, they do not prevent hernia complications. At present, the different anaesthetic techniques in elective surgery produce almost zero mortality, so a patient should not be refused surgery because of medical problems or age. However, to repair a large hernia, especially an eventration, it may be necessary to prepare the patient beforehand. Smoking and weight loss if obese should be avoided, as these are the main risk factors for the development of complications and recurrence.
What does the intervention consist of?
In most cases, the operation is performed under regional anaesthesia. It consists of closing the hernia defect by placing a mesh made of material that is perfectly tolerated by the body. The objective of hernia and eventration surgery is definitive healing (our hernia recurrence rate is less than 1%). But this must be combined with good aesthetic results, by performing small surgical wounds and skin sutures typical of aesthetic surgery. All this makes for a comfortable postoperative period and a much quicker return to daily life and work. The use of trusses should not be considered an alternative treatment to surgical repair, as in addition to the discomfort derived from their use, they do not prevent hernia complications. At present, the different anaesthetic techniques in elective surgery produce almost zero mortality, so a patient should not be refused surgery because of medical problems or age. However, to repair a large hernia, especially an eventration, it may be necessary to prepare the patient beforehand. Smoking and weight loss if obese should be avoided, as these are the main risk factors for the development of complications and recurrence.
Can it be done laparoscopically?
Yes, our team has the necessary training and resources to perform laparoscopic surgery for both inguinal hernia and eventration. A careful assessment of each patient will serve to indicate the most appropriate technique for their case. In principle, patients with a recurrent inguinal hernia or those with a bilateral hernia are candidates for laparoscopic surgery. If the eventration is of medium or small size, treatment with this technique achieves excellent results. Mesh placement is also performed, but with only 3 incisions of approximately 1 cm. It may allow a quicker return to work and normal activities with a reduction in pain.