Groin and Abdominal Hernias
Hernia Surgery is essentially ‘general surgery’ as it’s a very common surgical problem. As such it is not strictly ‘Upper GI Surgery’, but many Upper GI surgeons including Mr Griffiths, have become expert at hernia surgery because of their exposure and training in keyhole surgical techniques. Hernias are defects or weaknesses in the abdominal wall which often cause pain, discomfort and bulges. The only successful treatments are surgical. The most common hernias types are inguinal, femoral, umbilical, epigastric and incisional hernias. The majority of hernias can be treated with keyhole surgery to minimize time off work and help in recovery.
What are the symptoms of a hernia?
The most common symptom of a hernia is pain and swelling at the hernia site. The swelling often gets bigger on exercise or coughing. Inguinal and femoral hernias affect the groin. Umbilical hernias affect the ‘belly button’ area. Epigastric hernias affect the area between the lower rib cage and the belly button. Incisional hernias occur in weaknesses from the incisions of previous operations.
What causes a hernia?
Patients at risk of hernias include older patients as the tissues weaken with age. However, hernias can also occur in young patients through weakness they are born with. Patients who cough or strain, due to a variety of reasons, are more at risk of a hernia. Inguinal hernias are more common in men.
Can I get my hernia fixed on the NHS?
Yes you can. However, the Royal College of Surgeons and the British Hernia Society have found that 57% of clinical commissioning groups (CCGs) are denying patients quick access to the procedure and restricting surgery to patients with severe pain or incarceration of the hernia. The NHS waiting lists are on the rise for this type of elective surgery.
Please see Hernia Surgery Rationing
What does incarceration mean?
A hernia is a defect (hole) in the abdominal muscles through which the abdominal contents (usually fat but sometimes intestines or other abdominal structures) can protrude. When you lie down the protruding bit usually drops back through the hole meaning there’s often nothing to see or feel… Unless the hernia is stuck in the hole in the muscles. If the hernia does not go back when you lie down this is called irreducible or sometimes incarcerated.
What happens if a hernia is left alone or not fixed?
For most patients the hernia will get bigger and more difficult to fix. In others it will stay the same. Some patients avoid surgery, but most need surgery at some point in the future. A rare scenario is that the bowel in the hernia could get trapped or strangulated (lose its blood supply).
This is an emergency and needs surgery with hours to stop the bowel needed to be removed. If the bowel dies within a hernia this can be a life threatening event. Fortunately this is rare, but it is definitely best avoided.
What are the benefits of private hernia assessment and surgical repair?
There are several advantages including prompt clinic appointments i.e. no waiting months for a routine NHS clinic appointment and consultant led and delivered care. Mr Griffiths is an expert at assessing patients with hernias and talking through the pros and cons of each treatment approach. He can offer open or keyhole surgical options depending on the size and location of the hernia and the patients’ preference.
Groin and abdominal hernia surgery
Mr Griffiths performs both keyhole and laparoscopic groin hernia operations. He is a specialist hernia surgeon and a member of the British Hernia Society. He performs both open and keyhole repair methods. Therefore can offer a balanced approach depending on the size, location of the hernia and the patient’s preference.
What about Mesh for hernia repairs?
There has recently been a lot of controversy in the press regarding the use of Mesh in hernia repairs and other surgical procedures. However, to some extent this has been confused by the risks in other surgical procedures (such as transvaginal tape procedures for incontinence) which have little to do with hernia surgery. Some surgical experts appearing in the news advocating tissue repairs appear to be promoting their own private practice without long term data on tissue repair or non-mesh techniques.
Mr Griffiths is a member of the British Hernia Society and fully supports their stance on the subject, which is to assess and counsel patients thoroughly before surgery and discuss the issues in person.
Mr Griffiths does offer suture repair for small umbilical hernias and some rare scenarios other types of hernia. However for the majority of patients Mesh repair is the safest and most reliable way to repair a hernia. Millions of hernia repairs have been successfully performed with mesh. Alternatives are available and can be discussed with you to help you make an informed decision.
Please see this article for further details.
British Hernia Society patient information sheet on groin hernia surgery
This is a comprehensive patient information sheet on groin hernias (these are inguinal and femoral hernias). It is produced by the ‘British Hernia Society’ and contains information regarding:
- What a hernia is
- Surgical options (keyhole and open surgery information)
- Risks of the procedures
British Hernia Society Patient Information – LINK -Adobe Acrobat document [1.6 MB]
What are the surgical options for Groin hernias?
Groin hernias can be fixed using traditional open surgery or ‘keyhole’ / minimal invasive surgery. There are pros and cons of each operation.
What does the open surgery involve?
‘Open’ surgery – This can be carried out under local or general anaesthetic. Your surgeon will discuss this with you. It’s called ‘open’ because a small incision is made in the skin (usually 6 to 8 cm), in the groin area. The open approach can be carried out using either general or local anaesthetic, and this will be dependent on both your current health condition and preference after discussion with your surgeon. At operation the hernia is identified and the hole is either stitched closed (not at all common now) or (much more commonly) a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.
Please see this youtube video which details the open surgical technique
What does the keyhole or laparoscopic hernia surgery involve?
‘Keyhole’ or ‘laparoscopic’ surgery – Your operation will be carried out under general anaesthetic. One small cut (1-2cm long) near the bellybutton and two small cuts are made in the lower abdomen. Carbon dioxide gas is used to inflate your abdomen and a small telescopic camera is then inserted to view the hernia from within the abdomen. This means that the surgeon is looking at the hole from the inside of the abdomen. A mesh is then place over the hole. It is a bit like repairing a puncture in a tyre with a patch from the inside.
Please see this youtube video which details the keyhole surgical technique https://youtu.be/mcln9KRot9I
