Hiatal hernia, a common condition affects about 20% of Americans, and the chance of infection increases with age, so that it is estimated that half (50%) of those over fifty years have some degree and according to Cleveland Clinic statistics, inguinal hernia affects about 25% of all adult men (the incidence of women does not exceed 10%).
Dr. Ahmed Suleiman, consultant and head of the Department of General Surgery, who specializes in the digestive system, at a Kuwait hospital, says a hernia, by definition, is the exit of part or all of the organ outside its normal limits, reports Al-Qabas daily.
It can be divided according to its location into:
— External hernia: It is prominent on the surface and its symptoms can be seen, such as hernia of the umbilical region (whether around or in it), hernia of the inguinal or pubic region, or hernia of the surgical area.
— Internal hernia: Hernia occurs internally and you do not see its symptoms, such as hiatal hernia (causing GERD), hernia of the abdominal membranes, which causes the intestines to enter into some of them or become trapped between the membranes.
Dr Ahmed said that the cause of the hernia is either the weakness of the membranes and muscles supporting the area, or the increase in pressure in the abdomen, which leads to the rupture of the supporting membranes.
Therefore, everything that causes high pressure in the abdomen may lead to hernia in vulnerable areas, such as Pregnancy – Chronic cough – Chronic constipation – Exercising vigorously, such as carrying weights without wearing a belt that supports the abdomen – Practicing work that requires carrying heavy weights or continuous screaming – Obesity – A large tumor in the abdomen – Difficulty urinating (the need to strain until urine comes out ).
Dr Ahmed pointed out that the hernia is not considered a disease, but rather it is a symptom of a problem that caused an increase in abdominal pressure, such as chronic constipation, obesity, urinary tract problems, or others. The cause may also be dangerous, such as the growth of a tumor in the abdomen.
He stressed the importance of accuracy in diagnosing the cause of the hernia so that it can be treated before undergoing surgery, thus ensuring its success and not recurring the problem in the future.
Dr Ahmed went on to say that Hernia symptoms are often disturbing only, such as pain in the area, bowel protrusion outside, and a change in the shape of the area. But it may also cause dangerous complications when the intestine gets trapped inside the hernia sac (which prevents blood from reaching it), as this leads to the death of intestinal tissue, dangerous infections and poisoning.
He advised the hernia sufferer to be treated early before it leads to serious complications. Even if the hernia is small, over time it will increase in size and increase the chance of bowel entrapment inside it.
Regarding treatment, Dr Ahmed said the goal of the operation is to close the hernia and provide support to the area.
This can be done in the classical way by suturing the area with special threads, or in the modern way by implanting a medical mesh (of a suitable size and material), where the surgeon selects the appropriate type of mesh and installs it through surgical binoculars or by completely opening the area.
He added, it is preferable to perform the first hernia operation for the injured person through the full open technique, in order to ensure that it is performed in an ideal manner and reduces the chance of recurrence in the future.
As for those who have previously undergone abdominal surgery, it is preferable to perform it through surgical binoculars, where the surgeon implants the appropriate type of mesh that will irritate the area until fibrosis forms on it that supports the area and closes the hernia. The mesh may also contain antibiotics or clips that you install.
Dr Ahmed stressed the need to treat the cause of the hernia before undergoing the operation, in order to prevent its recurrence in the future.
He explained, it is possible that the hernia will recur in the same area or another area if the person does not follow the instructions of the therapist and treat the cause.
He pointed out that the hernia could recur if the patient did not choose an expert surgeon who knows the type of mesh suitable for the patient and performs the operation well, preventing damage to the internal organs or causing blood clots, i.e. inflammation.
In a few cases, the cause may be infections due to the patient’s low immunity as a result of an immune disease such as Crohn’s, taking cortisone drugs, or undergoing treatment that suppresses immunity.
Dr Ahmed indicated that hiatal hernia may be the cause of some cases of GERD. By definition, GERD is the return (or ascent) of stomach acid against gravity and the gastric valve ring into the esophagus to reach the mouth and may enter the vocal cords and the lung.