WHAT ARE UNUSUAL HERNIAS?
- A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.
- Listed below are a number of unusual and rare abdominal wall hernias. These are defined by their location on the abdominal wall.
- Spigelian hernia
- Lumbar hernia
- Obturator hernia
- Sciatic hernia
- Supravesical hernia
- Interparietal hernia
- Littre’s hernia
- Perineal hernia
- Lagier’s hernia
- Cloquet’s hernia
- Valpeau’s hernia
- Serafini’s hernia
- Hasselbach’s hernia
- Partridge’s hernia
- The defects in these unusual hernias almost always contain a peritoneal sac.
- A hernia does not get better over time, nor will it go away by itself.
- Complications of unusual hernias such as incarceration, strangulation and obstruction do occur but at a low rate.
HOW DO I KNOW IF I HAVE AN UNUSUAL HERNIA?
- It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.
- The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
- Severe, continuous pain, redness, and tenderness are signs that the incisional hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.
WHAT CAUSES HERNIAS?
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. Smoking, obesity, malnutrition and pulmonary disease have been shown to be contributing factors.
WHAT PREPARATION IS REQUIRED?
- Most large hernias require at least an overnight stay in the hospital.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
- After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- It is recommended that you shower the night before or morning of the operation.
- If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
- After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
- Quit smoking and arrange for any help you may need at home.
HOW IS THE PROCEDURE PERFORMED?
There are few options available for a patient who has a hernia. Most hernias require a surgical procedure. Surgical procedures are done in one of two fashions.
I. The open approach is done from the outside through an incision over the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
II. The laparoscopic hernia repair is done with a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.
Other cannulas are inserted which allow your surgeon to work "inside." Three or four quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples. This operation is usually performed with general anesthesia.
WHAT SHOULD I EXPECT AFTER SURGERY?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.
- You are encouraged to be up and about the day of surgery.
- You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
- Call and schedule a follow-up appointment within 2 weeks after you operation.
WHAT COMPLICATIONS CAN OCCUR?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection. These are uncommon with hernia repair.
- There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
- Difficulty urinating after surgery is not unusual and may rarely require a temporary tube into the urinary bladder for as long as one week.
- Any time a hernia is repaired it can come back. This long-term recurrence rate is very low. Your surgeon can help you decide if the risks of hernia repair are less than the risks of leaving the condition untreated.
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids