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Surgical
The Anal Stenosis Project
Hernia
20% of the entire world will experience a hernia sometime in their lifetime. So what is a hernia and why is it important to have hernias repaired?
A hernia is a protrusion of a viscus through an opening in the wall of the cavity in which it is contained. An abdominal hernia is a protrusion of abdominal contents (usually bowel), through an opening in the abdominal wall.
Why does this need to be repaired? Although some hernias produce no symptoms, most produce mild to moderate discomfort.
The real risk is when bowel becomes trapped in the hernia and can no longer be reduced back into the abdomen. As the bowl becomes trapped it can swell, progressively cutting off first the lymphatic, then the venous, and finally the arterial blood supply to the entrapped bowel. The bowel will then die and if left untreated so will the patient.
Repair is strongly advised before incarceration and its progressive complications ensue.
Hernias occur in 2 main ways.
Congenital. The infant is born with a hernia. In males the testicle develops in the abdomen and migrates down into the scrotum. If the path through which the testicles descends (the process vaginalis) fails to close this results in an indirect inguinal hernia.
Acquired – hernias may be acquired as a result of torn muscle. In the inguinal area this is called a direct hernia.
75% of groin hernias occur in men. These are examples of inguinal hernias.
Repair – All hernias should be repaired when identified to minimize complications. Repair in children differs from adults. As on most children the hernia is indirect, the sac in dissected and removed (high ligation of the sac). That is all that is required an the inguinal canal is closed.
In adults it is felt that inherent floor weakness is best repaired using mesh. Mesh is not used in children as it cannot grow with the growth of the child. One of our major donations is mesh and suture to allow us to repair hernias. We also teach our techniques to the Cambodian surgeons so they can do what we do when we are no longer there.