Importance of timely Hernia repair and factors to consider

A hernia is a common medical condition that occurs when an organ or fatty tissue pushes through a weakened area in the surrounding muscle or connective tissue. There are various types of hernias, including inguinal, incisional, femoral, umbilical, and hiatal hernias. While not all hernias produce noticeable symptoms, delaying treatment can have significant consequences. This article explores the factors to consider when deciding whether to undergo hernia repair surgery and the potential risks associated with postponing this essential procedure.

One of the primary factors to evaluate when considering hernia repair is the presence and severity of symptoms. Hernias can manifest in various ways, with pain being the most common symptom. Patients may also experience a sensation of heaviness or fullness in the affected area, such as the belly or groin. Even if symptoms are minimal or absent, a hernia can still affect daily life and activities, potentially leading to time off from work or leisure pursuits.

Delaying surgery in the presence of symptoms, especially pain, may not be advisable. Surgeons typically recommend surgical intervention to alleviate discomfort and prevent the condition from worsening.
Postponing hernia repair surgery can pose several risks that patients should be aware of it. Incarceration: Hernias can become incarcerated, a potentially serious complication. In this situation, the hernia becomes trapped outside the abdominal wall, potentially cutting off its blood supply and obstructing the bowel. This condition, known as a strangulated hernia, requires emergency surgical repair. While not all hernias progress to this point, the risk alone underscores the importance of timely intervention.

Hernias tend to grow and widens  the defect  over time, which can exacerbate symptoms, including pain.   Sometimes  in  neglected  cases  hernia  grows  so  bigger  that  it  seems  to  be  the  size  of  the   belly. Larger hernias are often more challenging to repair, making early surgery a preferred option to prevent symptom escalation.

In most cases, hernia repair surgery is inevitable, even if the patient does not currently experience symptoms. Delaying surgery until the hernia enlarges and muscles weaken may result in a more complicated procedure and a longer recovery period. And  if  it  is  untreated,  it  may  poses  to  life  threatening   condition  by  getting  obstructed  and  strangulated

Age plays a crucial role in the decision-making process. Younger patients may benefit from hernia repair, as they are likely to be in better overall health and physical condition, leading to smoother surgery and recovery. However, for elderly individuals, especially those over 75, who are less active and have asymptomatic hernias, the risks of surgery may outweigh the benefits.

When it comes to hernia discussion, most of our attention and conversations turn towards hernias in men. Of course hernias are more common in men than women but women may suffer hernia and its related complications as well. In fact, hernias in women are subject to be underdiagnosed, misdiagnosed or even ignored by clinicians. The incidence of groin hernias in women is 1.9%. In other words, from every 50 women one could have groin hernia with the female to male ratio of 1:6. Positive family history is an independent risk factor for developing hernias in women. However, there are other conditions that indirectly increase the risk of hernias in female such as obesity, heavy lifting, chronic cough, chronic constipation and multiple pregnancies.

In most cases, the hernias have no signs or symptoms. These hernias are usually diagnosed at the time of a routine physical examination or during an operation for other surgical problems. Unfortunately, the painful but non-palpable hernias are extremely common among women due to their usually small hernia defects which creates an extremely difficult challenge in diagnosing the hernias in a timely manner.

The hernias in women should not be taken lightly or ignored. Once the hernias in women is diagnosed, the repair should be carried on as soon as possible, not only to decrease or relieve the pain and discomfort but also to prevent the complications related to the hernia such as incarceration.

Traditional treatment options for hernia, however, have greatly expanded in recent years. It has evolved to include not only traditional open surgery but now less invasive procedures - such as laparoscopic and robotic surgery. Regardless of the method, hernia repair typically involves using a piece of mesh to reinforce the weakness in the abdominal wall.

Open Repair: This type of approach is usually used for very large hernia defects as a part of abdominal wall reconstruction. The mesh is positioned between the muscles layers, to minimize complications and provide the most functional and durable repair.

Laparoscopic Surgery: Alternatively, a hernia may be repaired using a laparoscopic approach. The surgeon inserts small tubes called trocars through the abdominal wall at some distance from the hernia. A mesh prosthesis is then passed through one of the tubes into the abdomen and fixed to the undersurface of the abdominal wall with sutures and tacks. This technique is used for both small and large hernias of the abdomen.

In summary, the decision regarding hernia repair surgery should be carefully considered in consultation with a healthcare professional. Factors such as the presence and severity of symptoms, the potential risks of waiting, age, and overall health should all be weighed when determining the appropriate timing for surgery.

Surgery may disrupt one's routine, but it provides the advantage of control over the timing, potentially minimizing the impact on work and daily life. Additionally, laparoscopic hernia surgery, if applicable, offers a quicker return to normal activities and work.

Ultimately, the goal of hernia repair surgery is to restore the affected organ or tissue to its proper place and strengthen the weakened muscle or tissue, improving the patient's quality of life. Timely intervention can be crucial in achieving this goal and preventing the progression of the hernia.

Dr. Mohammad  Abdullah  Al  Mamun, Secretary  General, Hernia  Society  of  Bangladesh