WHAT IS HERNIA?

A hernia is a protrusion of a tissue, structure, or part of an organ through the muscular tissue or the membrane by which it is normally contained. The hernia has 3 parts: the orifice through which it herniates, the hernial sac, and its contents.

Hernias may present either with pain at the site, a visible or palpable lump, or in some cases by more vague symptoms resulting from pressure on an organ which has become "stuck" in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed by or accompanied by an organ.

HERNIA CLASSIFICATION

Hernias can be classified according to the location where they are present.
•  Abdominal hernias : Most hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or "defect", through which adipose tissue, or abdominal organs covered with peritoneum, may protrude.
•  Diaphragmatic hernias and hiatal hernias : For example, paraesophageal hernia of the stomach.
•  Pelvic hernias: For example, obturator hernia.
•  Hernias of the nucleus pulposus of the intervertebral discs: These cause back pain or sciatica.
•  Intracranial hernias: These are brain hernias caused by herniation of part of the brain because of excessive intracranial pressure.
•  Umbilical hernias : These involve protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall.

HERNIA COMPLICATIONS

Hernias can develop several complications:
•  Strangulation: Pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosis and gangrene, which may become fatal.
•  Obstruction: They may obstruct the normal functioning of or around the organ they affect. For example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, ileus, absence of flatus and absence of defecation. These signs mandate urgent surgery.
•  Organ dysfunctioning: Sometimes the herniated organ itself, or surrounding organs start dysfunctioning causing complications. For example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing sciatic nerve pain, etc.

HERNIA TREATMENT

To prevent complications such as organ dysfunction, gangrene, and multiple organ dysfunction syndrome, hernias should be repaired in a timely fashion. Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy).

If complications have occurred, the surgeon will check the viability of the herniated organ, and resect it if necessary. Modern muscle reinforcement techniques involve synthetic materials (a mesh prosthesis) that avoid over-stretching of already weakened tissue. Increasingly, some repairs are performed through laparoscopes.

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