Hernia- A Stich in Time Saves Nine

One of the most common problems, we dealt with, as surgeons is Hernia. It can occur in both males and females irrespective of one’s age group. In males the commonest affected area is the groin and in females it can occur in the belly button, previous surgical scars, etc. Other than these, hernias can occur in various different locations like epigastric region or in other areas of the abdominal wall. In fact, many do not know whether they have a hernia until they are aware about, what it is.

Hernia is a defect that occurs in the abdominal wall musculature or a weakness, through which your abdominal contents (bowel, fat or bladder) protrude out. They are varied depending on the area through which they protrude out, such as groin hernia, umbilical hernia etc. One may experience pain or swelling while straining or standing which needs to be checked by a doctor to identify if it is a hernia.

Many a times, we get to see patients who are themselves knowledgeable of having hernia, yet are reluctant to treat it till the pain develops. That is, they wait for the pain to come about, to get it treated. It is apparent to compare a heart disease to this which can be easily explained.

In order to prevent a heart disease, utmost steps like diet, lifestyle modifications and medications are followed because getting MI done can be fatal at times. Similarly, if a hernia is left untouched it becomes obstructed and could be lethal and requires immediate surgery within 4-6 hours or else the blood supply to the obstructed part might cease and this aftermath a much more complex procedure to handle, instead of a simple day care key hole surgery, that is offered for an uncomplicated hernia.

Comparing two case scenarios below: ?

An eighty-nine year old aged man was presented with a groin hernia on both sides, with no pain around it. He is diabetic and hypertensive as well, has had a history of a cardiac bypass done in the past. A complete pre-operative work up was done on this gentleman. An elective laparoscopic repair on both the sides of hernia was done in the same sitting with an operative time of 60 minutes. He was discharged the very next morning and went home walking without any pain or signs of a surgery done on the previous day.

On the contrast a forty-six year old lady with a long standing umbilical hernia, knew she had been having this for many years, but chose to ignore it since she had no pain. Occasionally, when she perceived the pain, she preferred counter medications. She was presented in the ER on a night around 11 pm with the symptoms of severe pain, vomiting, constipation and abdominal distension. She had a bowel obstruction due to the hernia and an emergency surgery was performed. Although, laparoscopy was decided, her intestines were gangrenous hence, had to carry out a large open surgery and the dead parts of the intestines were removed later established normal continuity. It was more strenuous and even ended up futile to a place a mesh in the infected and gangrenous bowel.

Evaluating both these cases, initial was an elderly man along with a lot of comorbidities but, evanesced in a day with the perfect repair for his hernia because he decided a planned elective surgery. But in the latter case, a much younger lady, but since being reluctant to present at the right time for the procedure, her hernia became complicated and she required exceeding than a normal hernia repair and that too without a mesh, for which she would necessitate another surgery.

Today, hernia surgeries are administered adopting minimal invasive (laparoscopic) methods, in a single day at the hospital. With the advancement of modern technology and infrastructure, a complete pain free post-operative period is facilitated where; most of the patients get back to their routine life within 48 hours and even fail to remember they are one.

A planned elective surgery is always the best preferred, than an emergency setting. With regards to hernia, the saying – A STITCH IN TIME SAVES NINE holds perfect.

Dr. Deepak Subramanian, Clinical Lead and Senior Consultant Department of General, Laparoscopic and Bariatric Surgery