HERNIA CLINIC OF BRISBANE
David J Phillips
M.B., B.S., F.R.C.S. (Ed) F.R.A.C.S.
SURGEON

OTHER HERNIAS

UMBILICAL HERNIAS
The type of repair used will depend on the size of the patient and the hernia, and will vary quite a lot. In general a small incision skirting the umbilicus will be used and the repair carried out with heavy nylon sutures and often mesh reinforcing. Patients with small hernias can leave hospital the same or the next day. Swelling and infection of the wound is relatively common.

FEMORAL HERNIAS
These are uncommon hernias, which arise below the groin and are more common in females. They are extremely dangerous with a very high risk of bowel strangulation and must be repaired as soon as practicable. Usually a small incision below the groin is all that is necessary and most of these are repaired by open surgery. Because no muscle needs to be cut and a small plug of mesh closes the hernial defect, there is usually no great incapacity following surgery. Laparoscopic repair can be used as an alternative method.

INCISIONAL HERNIAS
These are hernias, which have occurred through the sutured wounds of previous abdominal operations. The repair varies with the type and size of the hernia but in general they require wide exposure of good abdominal wall muscle and a large sheet of mesh to reinforce any sutured repair. Time in hospital is often 4 or more days and recovery is slow. Laparoscopic repairs can be performed in some cases inserting the mesh on the inside of the abdominal cavity and hence avoiding the very large incision and tissue dissection. Recovery is therefore much quicker as the pain is greatly reduced.

The open surgical techniques to repair these types of hernia and the types of mesh have been changing and improving over recent times. My preferred method is to place reinforcing mesh deep to the muscle layer, whenever possible, but still in front of the abdominal lining layer. This preperitoneal repair is not always technically possible to perform, but where it can be, it leads to a very reduced amount of surgical dissection in the fatty tissue layer in front of the muscle layer. Therefore there is much less post operative pain, and much quicker discharge from hospital and return to full activities. There is also a reduced risk of the wound and the mesh becoming infected.

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