Dr. Ertan Beyatlı

Is surgery necessary for hernia?

(Update: ) - Hernia

Hernia is a very common word in society. The origin of the word is Arabic. In this article I will give information about hernia. Anything you can think of, including causes, symptoms and treatment methods ..

Hernia is a curable disease.

What is a hernia?

A hernia is when some of the abdominal contents protrude through a weak spot in the abdominal wall.

Many hernias are asymptomatic but cause pain when complications develop and require immediate surgical intervention. Diagnosis is clinical. Treatment is elective surgical repair.

It is a swelling under the skin of the internal organs emerging from the tear in the abdominal wall. Swelling occurs and disappears from time to time. Swelling occurs when you stand up, cough, strain, and disappear when you lie on your back. The reason why the swelling disappears when lying down is that the organs in the hernia sac return to the abdomen.

The internal organs that cause swelling in the abdominal wall are often the intestines. In the progressing stage of the hernia, the swelling becomes continuous and the patient pushes the hernia with his hand to relax.

Abdominal wall hernias arise from a congenital or acquired weak spot. Inguinal hernias, umbilical hernias and umbilical hernias are examples of hernias that arise from a congenital weak point.

Weak points that occur later are the surgery sites. Hernia in the previously operated place incision hernias called. In these people, situations such as heavy lifting, chronic constipation, cough, straining, and difficulty urinating that suddenly increase the intra-abdominal pressure facilitate the formation and emergence of the present hernia.

Hernia
Hernia

Causes a Hernia

Approximately 90% of abdominal wall hernias inguinal hernias. Inguinal hernias are more common in men.Umbilical hernias Hernias that come out of the umbilical socket. The umbilical pit, like the inguinal canal, is one of the congenital weak areas of the abdominal wall. Umbilical hernias are more common in women. Umbilical hernias are relatively rare and should be considered as umbilical hernias. Incision site hernias occur above the incision site in people who have previously undergone surgery.

The treatment of all abdominal wall hernias is surgical. We can compare the form of hernias to the ballooning seen in a vehicle tire. The hard tire of the vehicle, strong muscles in the abdominal wall; The thin inner tube is like the intestines. Generally, the tire is strong enough to protect the bladder and keep it inside, but when a weak spot occurs, the bladder will bubble outward. This situation is very similar to the formation of a hernia in a weak abdominal wall.

In general, the factors that cause hernias to occur are as follows:

  • General Tissue weakness
  • Weak spots in the abdomen. Holes and weak spots are formed due to the formations entering and exiting the abdomen.
  • Developmental diseases
  • Genetic Collagen disease
  • Trauma. Hard and blunt blows
  • Tissue weakness due to aging and pregnancy
  • Primary Nerve and Muscle diseases
  • Increased intra-abdominal pressure

Types of hernia according to complexity

  • Confidential - clinically undetectable; can cause severe pain
  • Can be reduced - Reduced - a swelling that appears and disappears
  • Non-reducible - Irreducible - non-disappearing swelling, high risk of complications
  • Bulludead - painful swelling with reduced blood supply, requires urgent surgery
  • Infarction - high mortality as hernia content is gangrenous

Hernia Diagnosis

With a simple examination, every physician can understand the abdominal wall hernia. The diagnosis of umbilical and incision hernias is very easy. A significant portion of the patients also notice that they have a hernia. The hazelnut-sized swelling that comes out of the belly can also cause pain from time to time. Incision site hernias, on the other hand, appear just above the surgery scar in people who have previously undergone surgery.

While the swelling caused by the hernia becomes evident with the typical maneuvers that increase the intra-abdominal pressure, it disappears by lying on the back. Umbilical and incision hernias may cause abdominal pain and swelling in some patients. These pains that occur after meals are in the form of cramps, but are mild and sometimes constipation. All these complaints occur with temporary compression of the intestines in the hernia sac from time to time.

Inguinal hernias, which are still in the initial stage, can occur with chronic pain without swelling, mostly in athletes or athletic people. In this case, it can be investigated whether the intestines enter the hernia canal and whether there is another pathology that will cause pain by examining the inguinal region with ultrasonography. Muscle tears seen in athletes are also painful point hernias, but ultrasonography is not sufficient here, MRI is required for the diagnosis of athlete's hernias.

Who can be seen

Hernias can be seen in men and women of all ages. Hernia is a disease that can be seen in everyone, from newborn children to elderly people. 90% of all hernias are inguinal hernias. Umbilical and incision hernias make up the remaining 10%. Inguinal hernias are more common in men and umbilical hernias in women.

Pregnancy triggers the emergence of umbilical hernia in women. Trocar site hernias seen after laparoscopic surgeries are also a kind of incision site hernia (Port Location Incisional Hernia). Hernia does not disappear with exercise, weight loss or medication. Hernias cannot be cured by leaving them on their own. After the hernia is diagnosed, it is better to repair it as soon as possible.

Hernia Risks

Untreated hernias, bowel knotting and in the next stage intestinal gangrene leads. The reason for suffocation is that the intestine turns around itself and gets stuck in the hernia canal. In cases where this is not noticed, gangrene occurs in the intestines with impaired blood circulation and a simple hernia disease requires urgent surgery. It can cause serious health problems.

In addition, a strangulated inguinal hernia can cause damage to the testicles in men. Surgery is the only known treatment method for hernia. Physical closure of the tear, which is a physical condition in the abdominal wall that causes hernia, is the only option. Some patients may feel a little relieved by using a hernia ligament or corset, but they do not contribute to the treatment of the hernia and do not protect it from the possible risks caused by the hernia.

Dual Mesh (Patch) Reaction Surgery

What is a dual mesh?

First, I think it is useful to mention a few points about the features of Dual mesh..

Dual mesh (composite) or bilateral mesh is a type of patch used in abdominal wall hernias. Usually with large hernias, recurrent in hernias or in patients with very weak peritoneum (fascia).

The most important feature of these patches is that both sides have separate surfaces. The inner side is slippery and soft and spreads over the intestines and other organs for the abdomen, while the outer side interacts and integrates with the peritoneum and subcutaneous deep tissues. Reaction and rejection conditions are very rare in dual meshes compared to other patch types.

dual mesh natural patch
dual mesh natural patch

About 35 years ago in our 4-year-old female patient who applied to our center for further examination and treatment, she was in another center. umbilical hernia Dual Mesh hernia (hernioplasty) surgery was performed with a closed (laparoscopic) method. Our patient has increasingly stomach painHe complained of constipation and weakness, and in the last 2 weeks, he stated that there was a swelling on the right side of his belly, as hard as a fist.

In the detailed physical abdominal examination we performed in our patient, a rigid, partially immobile mass approximately 5 × 8 mm in size was detected in the right peri umbilical region. In addition, our patient had an advanced degree of sensitivity at the umbilical level. In the abdominal tomography taken in our patient, a cystic lesion extending from the right peri umbilical region into the abdomen and containing a dense image of fluid was observed. Thereupon, the patient was prepared for the operation with a pre-diagnosis of dual mesh reaction.

As a result of pre-op examinations and consultations, the patient was taken into operation without wasting any more time. During the operation, a lesion of approximately 5 × 8 mm in the right peri umbilical region, which herniated from the port site, was consolidated and in the middle part containing dense purulent mai. In the sub-umbilical region, there was a pouch of approximately 150 × 200 cm, containing 10-20 cc of purulent fluid, necrotic tissues, and dual mesh collected in ball form. Also about 10 cm long incisional hernia seen.

Mesh excision and primary anatomical repair was applied to the patient, and a hemovac drain was placed in the sub-umbilical region.

Dual Mesh (Patch) Reaction Surgery
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