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Hernia
A Hernia is an out-pouching of intra-abdominal contents through a defect, or hole in the muscle. The abdominal muscles and bones of the pelvis prevent abdominal contents from drooping out under normal circumstances. The skin and fat below the skin do not provide any strength and stretch if there is a hernia present. Hernias can occur anywhere in the abdomen, but most commonly occur at weak points where a small tear can start, and enlarge over time.
Hernias can develop due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age.
Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. The common areas where hernias occur are in the groin (inguinal and femoral), belly button (umbilical), and the site of a previous treatment or surgical operation (incisional). Both men and women can get a hernia. It does not get better over time, nor will it go away by itself.
It is usually easy to recognise a hernia. Common symptoms are:
If you have any symptoms of a hernia or are concerned you might have one, see your GP and they can decide if you need to see a surgeon. You will need a GP referral to see Mr Karametos at one of our Melbourne Hernia clinics for specialist assessment and treatment.
Hernias do not repair themselves. Over time hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the hernia will develop a complication.
Hernias can develop due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age.
Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. The common areas where hernias occur are in the groin (inguinal and femoral), belly button (umbilical), and the site of a previous treatment or surgical operation (incisional). Both men and women can get a hernia. It does not get better over time, nor will it go away by itself.
It is usually easy to recognise a hernia. Common symptoms are:
- A bulge or bump in the groin area or at the belly button or abdomen
- Pain, discomfort or 'dragging' sensation at the site, especially after working, straining, lifting or bending
- Burning or gurgling sensation in the groin or abdominal wall
- Pressure sensation in the abdominal wall or groin
If you have any symptoms of a hernia or are concerned you might have one, see your GP and they can decide if you need to see a surgeon. You will need a GP referral to see Mr Karametos at one of our Melbourne Hernia clinics for specialist assessment and treatment.
Hernias do not repair themselves. Over time hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the hernia will develop a complication.
- Incarceration occurs with a long term hernia where the contents come out and stay out and are unable to be pushed back in. This often causes discomfort or mild to moderate pain.
- Strangulated hernia is a medical emergency and requires prompt attention at hospital. Strangulation is where in the short term the contents come out and can not be pushed back in, and where the defect causes such pressure on the blood vessels that the contents are starved of blood supply. This causes swelling, and severe pain.
Hernia Causes and Risk Factors
Many hernias are the result of a defect or weakness in the abdominal wall that was present at birth. There are also conditions and habits that can increase one’s risk of developing a hernia.
Potential risk factors for a hernia include:
Potential risk factors for a hernia include:
- Chronic cough
- Smoking
- Obesity
- Repetitive lifting of heavy objects
- Straining when lifting heavy objects
- Straining during bowel movements or urination
- Pregnancy
- Certain medications, such as steroids
- Previous abdominal surgery
Hernia in General
Hernias are considered as a weakness, defect, or 'hole' in the abdominal wall or other structure through which tissue or organs can move outside from their normal location. Mr Steven Karametos individualises each hernia and its treatment according to its location, contents, the age and medical status of the patient, symptoms it may be causing including pain or intestinal issues, and an assessment of the hernia's risk to the patient and the risk of surgery to repair it.
The key reason to repair a hernia in an adult is that they so not heal themselves, they tend to get larger with time, they often become painful and can strangulate. Strangulation is where bowel, organs or tissue become trapped in the hernia, gets starved of blood supply then becomes ischaemic or dies. Strangulation is life threatening and requires an emergency operation. Upon your initial consultation with Mr Steven Karametos, he will assess all these considerations especially the latter one and discuss with you.
The key reason to repair a hernia in an adult is that they so not heal themselves, they tend to get larger with time, they often become painful and can strangulate. Strangulation is where bowel, organs or tissue become trapped in the hernia, gets starved of blood supply then becomes ischaemic or dies. Strangulation is life threatening and requires an emergency operation. Upon your initial consultation with Mr Steven Karametos, he will assess all these considerations especially the latter one and discuss with you.
Inguinal Hernia
Inguinal Hernia: Mr Steven Karametos manages inguinal hernias on a daily basis. Inguinal hernias are among the most common of the abdominal wall hernias accounting for almost 75% with a life time risk of 27% in men and 3% in women. These hernias tend to form in the area where the blood vessels to the testicles move through the abdominal wall in men or where a small ligament to the uterus attaches in women. This area is a persistent area of potential weakness throughout one's life. Inguinal hernia can also arise right beside this area, in the floor of the groin. The exact location of the hernia does not impact how the repair is initiated. The operation to repair both types is very similar.
Abdominal Ventral/ Incisional Hernia
Abdominal Ventral/Incisional Hernia: Ventral or abdominal hernias occur when the intestine or other abdominal contents push through a weakness or 'hole' in the abdominal wall. If the bulge occurs in the area of a previous surgical incision, these hernias are referred to as incisional hernias. Hernias can develop in these incisions during the weeks, months or even years after the initial operation. These are many factors that can affect the formation of an incisional hernia including smoking, being overweight, diabetes, and a person's genetics which dictates the type of healing tissue the patient naturally forms after a surgical incision.
Femoral Hernia
Femoral Hernia: Femoral hernias are often categorised with and compared to inguinal hernias, but they occur just under the groin. They are most common in women, but men do develop them as well. They occur when there is a weakness near the blood vessels travelling from the abdomen to the upper thigh. They are hard to distinguish from inguinal hernias on a physical examination. They carry a significant risk of strangulation.
Hiatal Hernia
Hiatal Hernia: Hiatal hernias occur when the stomach slides up through the diaphragm into the chest. Paraesophageal hernias are more dangerous and occur when part of the stomach is free enough to twist on itself. This can lead to significant symptoms and even strangulation, which would require emergency medical care and surgical correction. These hernias are not abdominal wall hernias and are treated in a very different way from inguinal and ventral or incisional hernias. Hiatal hernia and Paraesophageal hernia are part of Mr Karametos's speciality and interest, please make an appointment for further assessment.
Umbilical Hernia
Umbilical Hernia: An umbilical hernia occurs in the naturally weakened area of the navel where the umbilical cord was attached as an infant. When seen in babies or small children these hernias frequently get smaller on their own as the child ages. In adults these hernias do not close on their own and the only way to treat them is through surgery.
Spigelian Hernia
Spigelian Hernia: Spigelian hernias are technically ventral hernias, as they form in the abdominal wall. These hernias are uncommon and unique because they form between the layers of muscle of the abdomen wall. They cary a high risk of strangulation. Mr Karametos has pioneered an endoscopic, keyhole technique for repairing spigelian hernia without entering the abdominal cavity.
Complex Hernia with Abdominal Wall Reconstruction
Multiple hernia repairs? Mr Steven Karametos is a leading Australian surgeon who specialises in lasting, permanent complex hernia repair.
In recent years, the complexity of patients and difficulty of hernia repair has dramatically increased. A growing number of patients have large or complex hernia and abdominal wall defects. These defects may be the result of an incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, or catastrophic injury or infection.
In cases of multiple previous failed hernia repairs or catastrophic injury to the abdominal wall, or for very large hernia, advanced hernia repair techniques are often required to reconstruct the abdominal wall properly.
The goal of complex hernia repair with abdominal wall reconstruction is to repair the hernia defect, reinforce the abdominal wall to prevent recurrences or other hernias from developing, recover abdominal wall functionality, prevent intraabdominal organs from protruding through the abdominal wall, and provide a cosmetically-pleasing appearance.
During the procedure, Mr Karametos may need to rearrange the abdominal muscles in order to close the hernia defect. The abdominal wall is then reinforced with mesh which may be absorbable.
The end result of this complex abdominal wall reconstruction is a restored, physiologic and functional abdominal wall with enough strength and flexibility to withstand physical activity and to improve quality of life. When performed properly by specially trained surgeons, complex hernia repair generally has a low rate of relapse, resulting in a long-term functional repair with an esthetically-improved result.
In recent years, the complexity of patients and difficulty of hernia repair has dramatically increased. A growing number of patients have large or complex hernia and abdominal wall defects. These defects may be the result of an incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, or catastrophic injury or infection.
In cases of multiple previous failed hernia repairs or catastrophic injury to the abdominal wall, or for very large hernia, advanced hernia repair techniques are often required to reconstruct the abdominal wall properly.
The goal of complex hernia repair with abdominal wall reconstruction is to repair the hernia defect, reinforce the abdominal wall to prevent recurrences or other hernias from developing, recover abdominal wall functionality, prevent intraabdominal organs from protruding through the abdominal wall, and provide a cosmetically-pleasing appearance.
During the procedure, Mr Karametos may need to rearrange the abdominal muscles in order to close the hernia defect. The abdominal wall is then reinforced with mesh which may be absorbable.
The end result of this complex abdominal wall reconstruction is a restored, physiologic and functional abdominal wall with enough strength and flexibility to withstand physical activity and to improve quality of life. When performed properly by specially trained surgeons, complex hernia repair generally has a low rate of relapse, resulting in a long-term functional repair with an esthetically-improved result.
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