Hernia Types & Treatments
Groin hernias can occur in anyone at any age, but are more common in men than women. They usually occur when the muscle in the groin weakens sufficiently to allow the bowel or its lining to poke through gaps in these muscles. Occasionally a fall or a blow can tear the muscles so that the hernia develops rapidly.
The developing hernia may appear as a bulge in the groin, usually on standing or straining. In the early stages, this bulge will usually disappear when lying down.
Hernias can be painful when they first appear, but this usually settles within a few weeks. More commonly the hernia when visible is associated with a dragging, rather unpleasant sensation which is made worse when gardening, doing DIY, lifting heavy objects or straining.
Some people have these from infancy, but most will develop in adulthood, either as a result of pregnancy or as a result of general abdominal weakness.
The umbilicus starts to stick out, first of all when straining, then eventually at all times. The hernia in this case usually consists of internal fat, and repair is relatively straightforward. It is not always necessary to insert a mesh when performing the repair; other techniques may be more suitable.
Although most hernia repairs are successful, they can never make the tissues as good as new. There will always be a risk that the hernia comes back: a recurrent hernia.
The chances of recurrence increase with loss of muscle tone, increased girth or the development of a chronic cough. The risk of a groin hernia recurring is said to range from 2% to 5% over a ten year period, but may rise to 10% in some cases.
Recurrent hernias can be repaired, sometimes more than once, but the law of diminishing returns will apply. Your hernia surgeon should be able to discuss how to avoid a recurrence, and the risks of recurrences occurring.
Any operation on the abdomen requires an incision through the abdominal wall (including the muscles) in order to access the organ to be treated, such as the gall bladder, the bowel or the womb, etc. Even keyhole surgery requires these incisions, although the muscle disruption in keyhole surgery is small.
Although the abdominal structures are repaired at end of the operation, the wounds consist of scar tissue which is weaker than normal tissue. Occasionally the scar tissue breaks down and a hernia develops at the site of the incision: an incisional hernia.
These are often uncomfortable, and can vary enormously in both size and complexity. Most require repair, but some can be managed without surgery. Your hernia surgeon should be able to advise as to the best course of treatment to follow.
Given their position in the human body, it is not surprising that two of the most significant drawbacks to surgical repair of groin hernias are recurrence and the development of chronic pain at the site of the repair. Chronic pain may develop in up to 12% (1 in 8) patients following routine hernia repairs, whether performed by open surgery or using keyhole techniques. The causes of the pain are poorly understood, but much research has gone into avoiding this problem by developing new approaches to hernia repair. One of the more successful of these was the development of the pre-peritoneal repair technique of Pélissier TIPP technique) which Mr Baskerville helped develop in the U.K., and which has been associated with a significant reduction in post-operative chronic pain.
In 2011, the technique was simplified and renamed ONSTEP (Open Non SuTured Extra Peritoneal repair). Mr Baskerville and a group of hernia specialists in Europe have been developing this technique and have now treated over 1,000 patients: ONSTEP appears to combine a successful repair with little or no post-operative pain. It can be performed safely as a day case, under local anaesthesia when required. ONSTEP is also associated with a very rapid return to normal activities.