TREATMENT OF HERNIA (2)

In the first part of this piece, it was stated that hernia is a common surgical condition in our environment and constitutes a serious problem in the male gender. Complications are frequently seen, especially due to increased physical activity or as a result of hard labour.

A hernia occurs when part of the bowel sticks out through a weak area in the muscles of the abdomen, causing a bulge or lump which can be felt under the skin.

A hernia can be uncomfortable and feel tender, especially when bending or lifting.

Types of hernia 

An inguinal (groin) hernia: This is the most common type of hernia. It is much more common in men than in women.

A femoral hernia: This is more common in women than men. It is usually seen as a lump in the lower groin, near the skin crease towards the top of the thigh.

An epigastric hernia: This is caused by the weakening of the muscles in the central, upper abdomen, causing a lump or bulge to appear anywhere between the lower part of chest and the navel.

An umbilical hernia: This occurs at, or near the navel. It is very common in children. In adults, it is more common in women, often in those who have had children.

An incisional hernia: This may occur at any site where an operation has been performed previously. The scar represents a weakened area, which, over time, may allow the intestines underneath to bulge through.

Strangulated hernia: Sometimes, a hernia can become ‘strangulated’ – that is trapped in the gap it has come through. This can cut off blood supply to the affected organs. It is a surgical emergency.

Treatment

Surgery is the only way to repair a hernia. The surgery is called herniorrhaphy, while the surgery for children is called herniotomy. Surgery has generally been recommended for all inguinal hernias to avoid complications.

There are two types of surgery: open surgery and laparoscopic (key-hole surgery). I will limit myself to the open surgery for the purpose of this piece.

In open surgery, a surgeon makes an incision in the patient’s abdomen, and pushes the bulging tissue or organ back to where they belong and repair the defect in the muscle tissue.

Complications of surgery

The risks of hernia repair surgery are minimal and are not common, as a lot of people entertain fears because of anticipated complications. The likely complications include temporary swelling or scarring at the site of surgery, swollen testicles, bruising (haematoma); while infection deep inside the groin or in the wound on the skin may be present for a few days after the operation.

Risk of the hernia reoccurring after surgery may happen in about three to five per cent of people.

Preparation for hernia operation

Do not smoke on the morning of surgery, do not eat any food, chew gum or suck sweets after midnight prior to the day before your operation; drink plenty of fluids, preferably water the day before the operation to help keep the body hydrated.

The blood pressure, pulse, temperature and some basic laboratory investigations will be done to certify the patient fit for surgery.

The surgeon will see you beforehand to talk to you about the operation and to answer any remaining questions you may have. The surgeon will ask you to sign a consent form which will describe the risks and benefits of the operation.

Post-operation advice

Upon discharge, it is essential that you have a responsible and able adult to take you home and to stay with you overnight and the next day.

Medications: Painkillers, vitamins and antibiotics are given to take home with you. I recommend that you take your drugs at regular intervals for the first few days in order to get maximum benefits such as pain relief.

Most people continue to experience some discomfort for a few weeks after the operation, but this will gradually stop.

If you are about to cough or sneeze, it will help if you put supportive pressure on your wound site with your hand or with a small pillow.

Wound care

The wound should be kept dry for the first two days. After two days, you can have a shower. It is important you do not stay in bed. Gentle exercise such as walking is beneficial. Do not lift any heavy object or do anything that involves strenuous pushing, pulling or stretching for four to six weeks.

Sexual activity can be resumed as soon as you are comfortable enough. It is advisable to have a high fibre diet to avoid constipation, as this will help reduce the strain on the site of the operation.

You may drive again when you can confidently perform an emergency stop without worrying about your hernia repair. This is usually between seven and 14 days after the operation.

The Graceland Hernia Foundation, a non-governmental and not-for-profit organisation is organising a surgical mission next month in Ajah, Lagos, where all forms of hernias and hydrocoeles in children, the elderly and the young will be operated on after necessary screenings.

Date: Friday, May 1 and Saturday, May 2, 2015. Time: 8:00am.

Contact details: 08023724546, 08186549147.

The leader of the surgical team is Dr. Paul Jesuyajolu, the founder of Graceland Hernia Foundation and executive member of the National Association of Rural Surgical Practitioners of Nigeria. He is also a member of the Association of Rural Surgeons of India.

Kindly visit http://www.gracelandherniafoundation.com to see the last surgical mission done a year ago at Ilu Titun in Ondo State, where about 50 people with hernias, hydrocoeles and other growths were operated on successfully. .............................................Concluded.