Surgery is the best alternative for strangulated hernia

To say that someone has a hernia really means very little, as a hernia is merely the rupture of tissue out of its normal position, into a place where it is not normally situated.

There are therefore many different types of hernia in the body. Some are quite rare, but among the more common types are the hiatus hernia (where part of the stomach slides into the chest), the umbilical hernia (where fat or gut bursts out through the wall of the abdomen to lie under the skin around your belly button), the femoral hernia (which can occur in a woman’s groin), and the most common of all, the inguinal hernia.

The inguinal hernia occurs almost invariably in men, and the reason for this goes back to the time when the man was still a fetus in his mother’s womb.

The testicles develop inside the abdomen, and before birth they migrate down into the scrotum. Behind them as they move down, they leave a tube (called the inguinal canal), that in the adult is 10 to 12 cm long.

Through this tube run the arteries, veins and nerves that supply the testicles. The small vas deferens, a duct that carries the sperm from the testicle to the base of the penis, also passes through the tube left by the descending testicle.

Shortly before birth, the inguinal canal closes down so that it is almost shut, leaving just enough room for the vital supplies to pass to and from the testes.

In some little boys, the tube does not close properly, and this allows a small amount of fat or intestine to move down the tube from the inside of the abdomen, to form a hernia just under the skin beside the penis.

In most men, the tube shuts effectively, but it remains a source of weakness in the strong muscle wall of the abdomen.

It should now be fairly obvious why this type of hernia is rare in women!

If excess pressure is put on the lower part of the belly by heavy lifting, prolonged coughing or some other form of strain, the closed inguinal hernia may tear open again, allowing some of the gut to protrude as a hernia.

Men who are overweight and have their muscles weakened by fat deposits, are more likely to develop this type of hernia, and the slackening of muscle tone with advancing age can also lead to a rupture. There is also an hereditary tendency, so that if your father had a hernia, your chances of developing one are increased.

Once a hernia is present, it may be only mildly annoying after exercise, or it may become very painful, and occasionally the gut inside the hernia may become strangled in the inguinal canal, causing that section of gut to be come gangrenous. This is a surgical emergency.

To prevent this emergency from occurring, and to relieve the discomfort of the hernia, doctors usually recommend that it be surgically repaired.

This is a relatively common and simple operation in which the inguinal canal is opened, the protruding gut is replaced in the abdomen, and the tube is sutured closed in several layers to prevent a further rupture.

Sometimes material similar to mosquito netting is stitched into the muscle layers to further strengthen the area.

There is some post-operative soreness, but most people can return to office work after 2 or 3 weeks, and heavy labor after 6 to 8 weeks.

In some older men, particularly if the hernia is very large, surgical repair is not practical, and a suitable truss is used to hold the bulging hernia in place. These larger hernias are less likely to strangle.

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