Hernia Types

Epigastric Hernia

An Epigastric Hernia occurs in the upper abdomen between the breast bone and belly button and develops in a similar way to an umbilical hernia. As hernias of this kind are generally quite small it is possible to have more than one at a time.

Causes Of Epigastric Hernia

An Epigastric Hernia usually occurs at birth but it can also develop in adults on rare occasions. A hernia of this kind can be caused by the weakening of the abdominal wall, coughing, straining on the toilet, heavy lifting, obesity, or a build up of fluid in the abdomen.

Symptoms Of Epigastric Hernia

In babies and young children, there will be a noticeable lump which will be more apparent when pressure is put upon the abdomen. In adults, there is usually swelling or a bulge in the upper abdominal area (the epigastric region) that is visible when pressure is applied to the region e.g during bowel movements, when coughing or during heavy lifting. The bulge can range from the size of a small grape to a large grapefruit.

Epigastric Hernia Treatment

Epigastric Hernia Surgery is the recommended option. Even though an epigastric hernia can be relatively painless, if they are left untreated they can enlarge. Leaving them alone can also increase the risk of strangulation , making them more difficult to repair.

There are two main surgical repair treatments available for those suffering from the condition:

Open mesh repair- A small incision is made at the hernia site, the bulge is returned, and a fine mesh is placed over the opening. The body then heals around it.

Keyhole surgery (Laparoscopic repair) – Four small incisions made through the abdominal wall. A small thin telescope and surgical instruments are then positioned to examine and deal with the hernia internally

You can review the hernia repair methods we offer at London Hernia and then contact one of our expert Consultants to discuss the best surgical procedure for your individual case.

Is No Treatment An Option

Many hernias do not hurt so the temptation is to ignore them and not seek medical advice. However this can be damaging and is not recommended. If left untreated an Epigastric Hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Inguinal Hernia

An Inguinal Hernia is the most common type of hernia and accounts for roughly 70% of all hernias cases. It is also one of the most common general surgical procedures. An inguinal hernia usually occurs when fatty tissue or a part of your bowel, such as the intestine, pokes through into the groin at the top of your inner thigh. It is a type of hernia that is more prevalent in males.

Our team of expert consultants are vastly experienced in the treatment of inguinal hernias and use the latest repair techniques to ensure excellent results, the fastest possible recovery and a minimal chance of re-occurrence.

Why Does An Inguinal Hernia Occur?

An inguinal hernia will occur through weakening of abdominal muscles around the inguinal canal allowing the pressure of internal organs to create a swelling or lump in the groin. The inguinal canal is a passageway between the abdomen and the genitals that is much larger in men than women. As a result this condition is far more common in males.

Inguinal Hernia Symptoms

You will see or feel a lump or swelling under the skin that may be uncomfortable, painful and sensitive to the touch. The swelling will often disappear completely when you lie down, as the ‘contents’ of the hernia sac slip back through the hole into the abdomen. In some cases there may be no visible signs of swelling, but you may be conscious of a strange feeling in the groin when you are standing or walking for any period of time.

Additional symptoms:

  • Pain from coughing, during physical activity
  • Burning sensations
  • Feelings of heaviness or full sensation in the groin
  • Swelling of the scrotum (men)

How Will I Know If I Have An Inguinal Hernia?

Generally hernias are painless but occasionally patients may feel slight discomfort when bending, lifting or standing for long periods of time. There is a high chance you have an inguinal hernia if there is a bulge or swelling under the skin in the groin area that disappears when you lie down. It is important to see your GP to confirm the diagnosis even if the hernia causes no pain. Your GP will then refer you to a specialist hernia surgeon.

How Will I Be Assessed For Inguinal Hernia?

It is likely you examined standing rather than laying down. If all the obvious signs are there it is unlikely you will be sent for further specialist tests.

Situations that may require further testing:

  • There is pain or discomfort in the groin with no obvious swelling
  • The swelling is not reducible and does not go back when you lie down

Inguinal Hernia Surgery Timeline

At Cheshire Hernia Ckinic we offer rapid access/turnaround from consultation to surgery. We can work around your schedule to sure you are returned to full health as soon as possible. For the next available surgery slot we recommend.

Inguinal Hernia Treatment Options

Surgery is the recommended option but the form of Inguinal Hernia repair administered varies on a cases by case basis. At London Hernia we offer the latest techniques to ensure you recieve the highest quality of repair and recover quickly.

The repair methods we offer:

Open Mesh Repair

Open mesh or tension free mesh is an advanced technique that was pioneered by London Hernia Consultants and has been perfected over thousands of successful operations. It involves the positioning a piece of fine mesh over the opening. The body will then heal naturally around it. This is a reliable repair with a high success rate that can be carried out in minutes under local anaesthetic.

Keyhole Surgery (laparoscopic)

This process involves four small incisions made through the abdominal wall through which a small thin telescope and surgical instruments are positioned to examine and deal with the hernia internally. This minimally invasive technique uses carbon dioxide gas to inflate the cavity to allow space for the surgeon to work remotely. The hernia hole is located and covered with mesh, which is stapled into place.

Using a Truss Or Fitted Belt

Using a truss or fitted belt is an old fashioned method that is both awkward and uncomfortable. They also rarely fit well enough to stop the hernia popping out. Trusses are okay if you too unwell or completely against having an operation – but they are a poor solution to the problem.

At London Hernia our surgical techniques are extremely effective and are able to be carried out under local anaesthetic. This ensures you don’t have to be asleep –‘knocked out’ – under a general anaesthetic.

Is No Treatment An Option?

As many hernias do not hurt the temptation is to ignore them. However failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Inguino-scrotal Hernia

An inguino-scrotal hernia is an advanced form of an inguinal hernia where the bowel has passed completlely through the inguinal canal and has entered the scrotum. An inguino-scrotal hernia is often more uncomfortable than an inguinal hernia, and is therefore more difficult to push back in. An inguino-scrotal hernia is often unsightly and the likelihood of strangulation of bowel is higher than with inguinal hernias.

Sports Hernia

Also known as “Athletic pubalgia” or “Gilmore’s groin” a Sports Hernia is an often painful, soft tissue injury that occurs in the groin area. Commonly confused with a traditional abdominal hernia, when the contents inside your abdomen push through a weakness in your abdominal wall, a sports hernia is a strain or tear of any soft tissue (muscle, tendon or ligament) in the lower abdomen or groin area. It often occurs when playing high intensity sports that involve rigorous movement and direction changes.

Sports Hernia Causes

A Sports hernia is a common injury that often occurs during high intensity sports where a great deal of stress and strain is placed on the groin and pelvic area. It’s is commonly associated with sports such as football and rugby as they involve a lot of twisting, turning and kicking movements.

Sports Hernia Symptoms

For many patients it can be difficult to name the exact location of the pain if they are suffering from a Sports Hernia.

Common symptoms include:

  • Pain can felt in the groin region, usually in the adductor muscle, but can also be felt in the testicles in some instances.
  • Pain during movements and exercise, especially when twisting and turning.
  • Pain in the groin area that increases following sporting activity.
  • Feeling stiff and sore following sporting activities.

Initially someone suffering from a Sports Hernia may be able to continue playing sport but over time it may get progressively worse and require treatment.

How To Treat a Sports Hernia

A Sports Hernia can be treated using both surgical and non-surgical surgical methods.

Non-surgical treatments generally involve a period of rest that is followed by a physical therapy regime. Doctors may then prescribe anti-inflammatory medications to reduce the swelling and pain.

Sports Hernia Surgery to repair damaged tissues in the groin can be carried out using either the traditional, open procedure, or as an endoscopic procedure. In an endoscopy, the surgeon inserts an endoscope (a small camera) through small incisions to treat the affected area. In some cases the surgeon may have to cut a small nerve in the groin (inguinal nerve) during surgery to relieve a patient’s pain. This procedure is called an inquinal neurectomy.

Umbilical Hernia

An umbilical hernia is similar to an epigastric hernia and occurs in the middle of the navel, with the inside of the navel sticking out. It is possible to occur in babies if the opening in the abdomen through which the umbilical cord passes doesn’t seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen. An umbilical hernia is similar to an epigastric hernia and occurs in the middle of the navel, with the inside of the navel sticking out.

Causes Of Umbilical Hernia

In babies, an Umbilical Hernia is caused when the umbilical cord passes through an opening in the baby’s abdomen. In some cases, this opening should close shortly after birth but sometimes the muscles do not seal completely. This leaves a weak spot in the surrounding abdominal wall and the hernia can develop when the-the fatty tissue/part of the bowel pokes through. In adults, Umbilical Hernia is caused by being overweight or obese, straining while moving or lifting heavy objects, having a persistent heavy cough or having a multiple pregnancy.

Symptoms Of Umbilical Hernia

A bulge or lump will appear beneath the skin. It can vary in size, depending on how big the hole becomes and how much pushes out. As with all suspected hernias, you should have it repaired as soon as possible.

Treatment For Umbilical Hernia

In children, the weak spot in the abdominal wall is closed with stitches (in most cases). If the hernia is large or in adults, a special mesh is used to strengthen the area.

Is no treatment an option?

Many hernias do not hurt so the temptation is to leave them and get on with life. But failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Incisional Hernia

An Incisional Hernia is the protrusion of abdominal contents through an incision in the abdominal wall that has failed to heal properly and has come apart. The incision would have initially been made during an abdominal surgical procedure such as bowel surgery. In rare cases the protruding abdominal contents will get trapped, resulting in a loss of blood supply. This is known as a strangulated hernia and requires emergency surgery. The best course of action is to seek immediate treatment; otherwise the hernia will almost certainly get bigger and more uncomfortable.

Causes Of Incisional Hernia

An Incisional Hernia occurs when abdominal contents protrude through an incision in the abdominal wall that was made during previous surgical operation. When conducting an operation a surgeon will make an incision to reach a patient’s internal organs. Once the operation is finished the surgeon will then close the layers of the abdominal wall with stitches. If the closure fails to heal properly or the stitches come apart over time, an Incisional Hernia can occur.

Incisional Hernia Symptoms

The main feature of an Incisional Hernia is a bulge under the skin, close to or beneath the incision scar. In many cases hernias are either painless or produce an occasional ‘ache’ after activity. In some cases however the pain will be quite marked.

Incisional Hernia Treatment

There are two standard methods of Incisional Hernia repair, the open technique or laparoscopic surgery. The treatment method administered is dependent on the nature of hernia, the desired outcome, a balance of risks and benefits, the patient and the surgeon. The type of repair is always tailored to the patient’s case.

Incisional Hernia Surgery Timeline

At London Hernia we offer rapid access/turnaround from consultation to surgery. With a wealth of talented surgeons and slots readily available in our state-of-the-art theatres, we can work around your schedule to ensure you enjoy a swift return to full health.

Is Incisional Hernia Treatment An Option?

Incisional Hernias almost inevitably enlarge over time so should therefore be repaired sooner rather than later. As many hernias do not produce any side affects the temptation is to ignore them. It It is therefore vital you seek treatment before the problem worsens. The larger the Incisional Hernia gets, the more difficult it is for a surgeon to carry out successful surgery.

Keyhole Surgery

During Hernia Keyhole Surgery (laparoscopic surgery) a surgeon will make four small incisions in the abdominal wall. They will then insert a small, thin telescope and the necessary surgical instruments so they can examine and deal with the hernia internally.

Laparoscopic Hernia Repair (Keyhole Surgery)

Hernia Keyhole Surgery, commonly known as ‘Laparoscopic Hernia Surgery’, involves the examination and correction of a hernia through four small incisions in the abdominal wall. This form of hernia repair allows the surgeon to deal with the problem internally.

This minimally invasive technique uses carbon dioxide gas to inflate the affected cavity so the surgeon can insert a telescopic camera and work remotely. One the hernia is located the hole is covered with mesh and stapled into place. The main advantage of using this technique is that no large cut needs to be made to the abdominal wall, thus speeding up recovery and reducing pain. The procedure must be must be carried out by a specialist surgeon experienced and skilled at laparoscopic techniques. Hiatus Hernia keyhole surgery is a particularly reliable form of this procedure. Keyhole surgery is particularly advantageous when used in bowel surgery where bigger cuts have previously been made or to deal with a failed open repair.

Is No Treatment An Option?

Many hernias do not hurt so the temptation is to ignore them. However, failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Stitching

Stitching was the most common method used around the world until the London Hernia Consultants perfected the Open Mesh system. It involves an operation under general anaesthesia where the surgeon pushes back the bulge and then places several layers of stitches under tension, which must hold the abdominal wall in place. Post-operative recovery can last up to a week and physical activity is not advised for some weeks. It can distort sensitive tissue and lead to pain when a patient coughs or sneezes.

Is No Treatment An Option?

Many hernias do not hurt so the temptation is to leave them and get on with life. However, failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Femoral Hernia

A Femoral hernia is a type of hernia that occurs when fatty tissue or a part of your bowel pokes through into the inner upper part of the thigh or groin. It is relatively uncommon and accounts for only 2% of all hernias and 6% of all groin hernias. Approximately 70% of femoral hernias occur in women as they generally have a wider pelvis and a larger femoral canal than men. As there are few femoral hernia symptoms it is estimated that nearly 50% of all femoral hernias are only discovered when strangulation occurs. Due to their location they can easily be confused with inguinal hernias by both patients and doctors.

Femoral Hernia Causes

In most cases the causes of a femoral hernia are unknown. You may be born with a weakened area of the femoral canal, or the area may weaken over time. Excessive straining can also contribute to the weakening of the muscle walls. This can occur during childbirth, through chronic coughing, when constipated or as a result of obesity.

Femoral Hernia Symptoms

A femoral hernia will appear as a small swelling, very low down your body, next to the groin or near the top of your thigh.

Often they produce few symptoms and very little little pain. It is therefore important to visit your GP if you suspect you have a hernia of this kind. If left untreated, a femoral hernia could strangulate. This when your bowel becomes trapped in the hernia and its blood supply is cut off. If strangulation occurs, the lump will become hard and tender, you will experience severe local and abdominal pain, nausea and vomiting. Even if your hernia is causing you no pain it is important to see your GP to confirm the diagnosis. Your GP will then refer you to a specialist hernia surgeon.

Femoral Hernia Treatment

A femoral hernia must detected quickly and repaired swiftly. Therefore surgery is the best option for anyone suffering from the condition. The aim of femoral hernia surgery is to close off the femoral canal. Before ‘mesh’ was introduced this was always carried out using stitches – stitching the front and back of the opening together. As this method is generally quite reliable and produces accurate results it is still the most common form of femoral hernia repair used in the UK. The problem however is that it can produce a lot of pain and the recurrence rate can be high.

As eluded to previously there is now another surgical treatment available to patients suffering from a femoral hernia, a mesh cone or plug.

Is no treatment an option?

As femoral hernias produce few symptoms the temptation is to ignore them. Failing to get medical advice however can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Open Mesh

Hernia repair using ‘open mesh’ or ‘tension free mesh’ is an advanced technique that was pioneered by our London Hernia Consultants and has since been perfected over thousands of successful operations. Hernia mesh surgery involves the positioning of a piece of fine mesh over the problematic opening. The body will then heal naturally around it. The ‘Open Mesh Repair’ technique can be carried out in minutes under local anesthetic and is renowned for its durability.

What Is Open Mesh Repair?

Perfected over thousands of operations it is now regarded as one of the most successful and reliable forms of hernia repair.

During an ‘Open Mesh Repair’ the surgeon makes a small incision at the hernia site. The problematic bulge is then returned and a fine piece of mesh, that is both sterile and inert, is placed over the hole. The hernia mesh implant is then held in place as the outer incision is closed so that the healing process can start. Sensing the presence of the mesh the body creates fibrous tissue to grow around and interlace it. This increases the strength of the area so the weakness that caused the hernia is eliminated.

Tension Free Mesh Hernia Repair has largely replaced the traditional procedure of stitching together the hernia opening. It is now a reliable alternative to the traditional method which can leave the hernia area weak and liable to further hernias. Open Mesh Repair is also preferred to the conventional method as it does not necessitate the use of general anaesthesia and it can be performed as day surgery with patients returning home the same day. As it is less invasive and tissue trauma is kept to a minimum, patients can also resume normal activity and work within days. There is also less chance the the hernia will reoccur.

Benefits Of Open Mesh Repair

  • A very short operation with minimal, if any pain
  • It can be performed under local anaesthetic
  • Rapid recovery, can go home on the same day
  • Extremely Reliable
  • Less chance of a possible re-occurrence
  • No issues for older patients
  • Procedure and aftercare is cheaper than other centres

Who Is Suited To Open Mesh Repair?

Only in extremely rare cases are we unable to treat a patient. At London Hernia we have operated successfully on a number of patients that have been turned away by other hospitals because of their age, breathing, heart conditions or complexity of the hernia.

The open mesh procedure is well suited to older patients as it eliminates the need for general anaesthesia and the rapid recovery rate means they can maintain their health and fitness.

Is No Treatment An Option?

As many hernias do not hurt the temptation is to just ignore them. However, not getting medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Stoma Hernia

A Parastomal Hernia (commonly known as a Stoma Hernia) occurs when part of the intestine protrudes though a ‘Stoma’, an opening that has been surgical created in the abdomen so waste can be passed into a bag. The bulge often protrudes further when coughing or undertaking physical activity. A hernia at a Stoma site is one of the most common complications following the surgical creation of a Stoma. A Parastomal Hernia (Stoma Hernia) is a weakness or protrusion in the muscle wall of the abdomen at the site of a Stoma which allows the abdominal contents to bulge out. The bulge often protrudes more when coughing or undertaking physical activity.

Why Do Stoma Hernias Occur?

A ‘Stoma’ is a surgically made opening in the stomach, small bowel, or colon that allows a patient to pass waste into a bag. Surgery of this kind is often necessary when patients have gastrointestinal problems that prevent them from having normal bowel movements. A Stoma Hernia is a common complication that follows this procedure. When a Stoma is brought to the surface of the abdomen it passes through the abdominal wall. In turn this creates a potential area of weakness. Usually the muscles in the abdominal wall form a snug fit around the opening, however, on occasion the muscles come away from the edges of the Stoma, creating a hernia.

A Stoma Hernia can occur like most hernias through coughing or from being overweight. It can also occur if there was an infection in the wound following Stoma surgery. It can also develop gradually as the the area near the Stoma stretches and weakens over time.

Stoma Hernia Symptoms

  • Changes in Stoma function or bowel habits
  • Bloating
  • Pain or discomfort around the Stoma
  • Pain or discomfort during heavy lifting or coughing
  • A bulge around the Stoma

Stoma Hernia Treatment

There are a range of options available to patients depending on their on their individual circumstances.

Is No Treatment An Option?

Many hernias do not hurt so the temptation is to ignore them. However, failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.

Hiatus Hernia

A ‘Hiatus Hernia’ is also known as a ‘Hiatal Hernia’ and occurs when the upper part of the stomach pushes up through the diaphragm and into chest region. It rarely produces noticeable symptoms but it can lead to gastro-oesophageal reflux disease (GORD). GORD occurs when a hiatus hernia prevents the valve at the bottom of the oesophagus from working properly, causing it to leak stomach acid into the oesophagus. This condition generally occurs in people who are over 50 years old.

Hiatus Hernia Causes

Unlike most hernias, a hiatus hernia does not occur within the abdominal wall, but within the chest area and affects the digestive system specifically.

‘Hiatus’ means ‘gap’ or ‘hole’ (in Greek). The gullet (oesophagus) is the passage that transports food from the mouth to the stomach. To get there it has to pass through a hole in a flat sheet of muscle that separates the chest (containing your lungs and heart) from your abdomen (where your stomach should live). Sometimes this hole enlarges and the top of the stomach passes upwards into the chest – this is called a hiatus hernia.

There are two types of Hiatus hernia:

  • Sliding hiatus hernia (80% of all cases)– hernias that move up and down, in and out of the chest area.
  • Rolling hernia (20% of all cases) – where part of the stomach pushes up through the hole in the diaphragm next to the oesophagus.

Hiatus Hernia Symptoms:

Unlike an abdominal hernia, hiatus hernia rarely produce symptoms. This can make them particularly difficult to diagnose. However, if you do experience any symptoms they are likely to be as below.

  • Bile
  • Stomach acid
  • Heartburn
  • Chest pain
  • Trouble swallowing
  • Belching
  • Air entering the oesophagus

Symptoms May Be Triggered By:

  • Foods or drink that is too hot
  • Spicy food
  • Acidic food
  • Smoking
  • Alcohol consumption
  • Obesity

Hiatus Hernia Treatment

The difficult part about fixing a hiatus hernia is that you can’t just close off the hole as a small gap must remain for the gullet to pass through.

Hiatus hernia surgery is usually done laparoscopically. Traditionally surgeons would use the ‘wrap around’ method, but now more and more are turning to procedures that involve mesh. Mesh repair is extremely technical and can be tricky to get right . The aim of the repair is to narrow the opening just the right amount. If the opening is left too wide the repair won’t prevent a further hiatal hernia. If the hole is closed too far the smooth transportation of food down the gullet will impaired . Alternative treatment can be provided to ease symptoms of acid reflux and heartburn for which medications may be provided.

Spigelian Hernia

A Spigelian Hernia is an uncommon type of hernia that occurs in the abdominal wall, slightly to the side of the upper abdomen. It can be repaired in a similar way to most other hernias using tension-free mesh reinforcement. Early symptoms may include a bulge appearing to the side below your navel or discomfort that may become more painful when lifting heavy objects or when coughing.

Strangulated Hernia

Is A Strangulated Hernia Dangerous?

As a Strangulated Hernia can cut off the blood supply to the tissues in the abdomen it is extremely dangerous and considered a surgical emergency that requires urgent professional attention. If left untreated it will cause severe pain.

Strangulated Hernia Symptoms

  • Severe or sharp pain
  • Vomiting
  • A burning sensation in the area of the suspected hernia
  • Blood in excrement

How Can I Prevent A Strangulated Hernia?

Strangulated Hernias are are generally more prevalent in patients who are suffering from smaller hernias. This is due to the fact larger hernias tend to push outwards more easily so there is less chance of them being trapped by the muscle opening. Prevention can only be achieved by fixing the hernia before it reaches this level of severity. Strangulation can occur at anytime and as a result we recommend treatment as soon as possible.

My Hernia Is Painful, Is It Strangulated?

Pain associated with a hernia doesn’t always mean it has become strangulated but if you are feeling pain you should seek medical attention.

If you are experiencing pain from your hernia we strongly recommend you get in touch with us to avoid further complications.

Is No Treatment An Option?

If you are suffering from a Strangulated Hernia you must seek immediate medical attention as it is classed as a surgical emergency.

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