A hernia is the prolapse or projection of intra-abdominal viscera, usually the small intestine, through an abdominal gap. It is an opening through which some viscera protrudes, which we perceive as a bulge
It usually appears in the most sensitive and weakened parts of the abdominal wall and takes the name of the area where it appears, such as: inguinal canal (inguinal hernia), navel (umbilical hernia), femoral ring (femoral hernia), midline (epigastric hernia) and surgical incisions (post-operative hernia).
“Hernia repair operations are among the most common surgical operations performed worldwide. Statistics show that hernia cases are increasing by 3% every year in the Western and developing world, which is probably due, among other things, to the increase in obesity and chronic constipation”, emphasizes Mr. Diamantis Thomas Director General Surgeon at Metropolitan Hospital .
What factors contribute to the appearance of hernias?
There are factors that favor the appearance of hernias, such as vigorous exercise, heavy, manual work accompanied by heavy lifting, prostatic hypertrophy, heavy lifting, chronic or severe coughing, constipation, pregnancy and obesity, as well as they have a complementary effect on increasing the pressure received by the abdominal walls from the inside.
“As a disease, it occurs in both women and men and does not improve with time, nor is there any possibility that it will ever disappear. On the contrary, a neglected hernia can even cost the life of the patient because of this and is a problem that must be treated very quickly. If neglected, it can lead to the tightening and “strangulation” of the intestine, which although sometimes is easily repositioned by the patient himself, in some cases where it is not repositioned, immediate surgery is required”, the expert points out.
Categories of hernias
• Congenital hernias: Appear in infancy or childhood and are due to incomplete convergence of a normal hole (hole) in the child’s abdominal wall. Usually, they heal on their own with the growth of connective tissue and the healing of the point of projection.
• Acquired hernias: They are the most common hernias in the human body. They are hernias that appear at older ages, as a result of weakening of the abdominal wall and/or increased intra-abdominal pressure. They never heal by themselves and their treatment is always surgical.
• Retractable hernias: They can return to their normal position inside the abdomen with gentle manipulations by the patient or his doctor.
• Non-resectable hernias: They do not return to their normal position inside the abdomen with the usual manipulations and over time create adhesions with the abdominal wall, which is why they need medical treatment.
• Tightened hernias: Appears, when in a non-retractable hernia there is tightening and disturbance of the blood supply of the organ that projects. Immediate surgical treatment is needed to avoid organ necrosis.
What are the symptoms?
Initially, the hernia appears as a soft, painless swelling of the skin, which with appropriate manipulations returns to the upright position and is accompanied by mild discomfort, such as a feeling of heaviness or dull pain at the site of the hernia, especially after prolonged standing or physical activity.
“But as the hernia grows and the skin protrudes more, the pain becomes more intense, sharp and occurs more often. Knowing that it will hurt, the patient avoids any physical activity that increases the pressure on his abdomen and very often holds the hernia point with his hand to reduce the impending pain.
The further it progresses, the more difficult it is to retract and it may develop inflammation manifested by severe pain and redness of the skin or tightening of the hernia that prevents adequate blood supply to the affected organ, resulting in ischemia. In this case, the pain is sharp and the hernia site becomes hard and particularly painful,” explains the surgeon.
How is a hernia treated?
“The only way to deal with and treat a hernia is surgery,” he states and continues: “As we mentioned above, some cases of hernia are treated with the traditional “open” method to close the gap in the abdominal wall from which the hernia protrudes, with various stitching techniques. However, as a method, it has a recurrence rate of around 6% and can allow hernias to re-form.
With the development of biomedical technology, in recent years, new methods have been developed that are less invasive and use materials that are completely acceptable to the human body, such as laparoscopy and the robotic method that is constantly gaining ground.
In laparoscopy, the recurrence rate is less than 1% and offers all the advantages of atraumatic endoscopic surgery, with almost zero complication rates. In this particular case, the hernia is repaired from the back side of the abdominal wall, with the addition of a large surgical mesh, which is applied over the gap and stabilized with surgical sutures or absorbable clips or surgical glue”, says Mr. Diamantis Thomas.
Advantages of the laparoscopic method
This technique allows the patient to recover faster and have less post-operative discomfort. It is a completely bloodless method, while the small incision of only 5 millimeters, which is made in order to enter the laparoscopic instruments, is made only in the skin and not in the muscles, as is required in the classic open operation.
In fact, one to two days after the operation, the patient feels completely healthy and immediately returns to his daily activities, while over the weeks, all the signs of the operation disappear completely.
Laparoscopic treatment of abdominal wall hernias is increasingly gaining the preference of surgeons and patients because of the lack of postoperative pain from avoiding a surgical incision and because it offers faster mobilization of the patient and reduced risk of infections.
The robotic repair of hernias
The robot is a tool that has come to help surgeons perform difficult and specialized surgeries. “It’s like being inside the patient’s abdomen, having our hands inside and with the 3D vision seeing everything in front of us. It has fifteen times magnification, there is a filter for the tremor of the surgeon’s hand, and the aesthetic results are excellent”, he adds.
What is Laparoscopic and Robotic Technique eT.EP?
The eT.EP technique is the extra-peritoneal repair of abdominal wall hernias. “It is the most advanced and newest Endoscopic (minimally invasive) inguinal hernia repair technique, through which we reach a point where with small movements we detach the pouch of the recto-abdominal wall from the hernia, redistribute the contents, suture the gap and place the mesh at a point where it does not come into contact with the viscera,” he adds.
As an operation, it is performed without large and painful incisions, with only 3 small holes of 0.7 cm, which allows the patient to leave the hospital just 3 hours after the operation.
What are the benefits of the robotic method for the patient?
“The benefits of this particular technique is that the mesh, as we said before, is placed in a place that does not come into contact with the viscera. This means that adhesions do not form, and we cannot injure them.
In addition, the patient does not need painkillers and can immediately leave the hospital and return to his daily life very soon, as it allows the surgeon to have excellent clarity of the area he is operating on as well as excellent precision of his movements”, concludes Mr. Thomas .
The Metropolitan Hospital, as a surgical center par excellence, has one of the most modern operating theaters in Europe, with ten rooms of all specialties and state-of-the-art equipment in each one. In particular, each room has triple supplies of medical gases, a telescopic tower for the latest generation anesthesia machine, combined with vital parameters monitoring monitors that are digitally connected to the Infirmary’s network, thus enabling two-way communication with each monitor in the Infirmary.
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