Functional classification of Hernia:

Grade I

  • Swelling appears on coughing/straining and disappears on lying down

  • Defect size finger breadth

Grade II

  • Small, indirect, incomplete reducible hernia

  • Swelling limited to inguinal canal

  • Moderate size direct hernia

  • Swelling present on standing and reduces in the supine position

  • Defect thumb size

  • Small indirect reducible

  • Reducible femoral hernia

Grade III

  • Moderate size indirect reducible

  • Swelling extends up to neck of the scrotum but not to the testis

  • Large reducible direct hernia

  • Recurrent groin hernia

Grade IV

  • Large, reducible, indirect

  • Sac extending up to testis

Grade V

  • Large complete indirect inguinal hernia partially reducible or irreducible
  • Irreducible femoral hernia

Types of Hernia

Inguinal (Groin) Inguinal hernias appear as a bulge in the groin. They are more common in men than women. Patients may develop small intermittent bulges that show up while performing strenuous tasks.

Femoral Hernias: Femoral hernias are the relatively rare type of a hernia that occurs below the groin crease on the anterior thigh. These hernias are far more common in females.

Inguinal (Groin): Ventral hernias occur on the anterior (front) abdominal wall at areas of weakness. It may occur as a result of prior surgery, coughing, heavy lifting, obesity, smoking or other disorders. Types of ventral hernias.

An umbilical Hernia: at the navel or belly button. Most common type of a ventral hernia.

An epigastric Hernia: middle of the abdomen above the belly button and below the breastbone. These hernias contain fatty tissue and often quite small.

Congenital Diaphragmatic Hernia (CDH) present at birth abdominal organs may slip into the chest cavity.

A Hiatus Hernia (a diaphragmatic hernia) – stomach or other organs of abdomen slips into the chest through the diaphragm (the muscle that separates the abdomen from the chest and help in breathing). Stomach or other organs of the abdomen may enter into the chest.

Hiatal hernias may be an incidental finding in chest X-Ray or may present as heartburn, regurgitation, reflux, chest pain, difficulty swallowing or painful swallowing.

Hiatal hernias
can be treated with medication and diets changes, but sometimes require surgery.

An incisional Hernia: Occurs at the site of a prior abdominal incision.

A parastomal Hernia: Occurs at the site of a colostomy, ileostomy or another stoma (intestines sutured to the skin).

A spigelian Hernia: Occurs in the lower quadrants of the abdomen, usually at or below the level of the belly button.

Sports Hernia: Sports hernias are small, painful hernias as a result of a tear in the abdominal wall. Most common in athletes in sports that involve twisting the leg while running full speed. Most patients present with persistent groin pain that lasts for months despite adequate rest.

Treatment of Hernia- Medicine or surgery?

There is no acceptable medical treatment of a hernia. Once a hernia has developed it will tend to enlarge and cause discomfort. Delayed hernia repair can result in complications.

If a loop of bowel gets caught in a hernia it may become obstructed or its blood supply may be cut off (strangulated). This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk most surgeons, therefore, recommend that surgery for a hernia should be performed as an elective procedure unless there are other serious medical problems.

What are Surgical Options for Hernia?

There are two main options for hernia repair:

Standard Open Repair

Performed routinely with local anaesthesia and intravenous sedation. It involves a 10cm cut in the groin, finding the hernia, reduction of contents back to the abdomen and patching the defect with polypropylene mesh to strengthen the area of weakness to prevent the hernia from coming back.

Tension Free Hernia Repair

Tension Free Mesh technique has preferred the method of hernia repair and ideal for Inguinal Hernia. An incision is made directly over the site of a hernia. Hernia content is pushed back inside and the Specially designed mesh is placed is placed on the inside of weakness in the abdominal wall. Mesh acts as a platform for new tissue growth and it incorporates safely into the abdominal wall.

Minimally Invasive (Laparoscopic or key hole) Repair

Longer time of rest (average 6 weeks) after surgery and the chance of a hernia coming back (a recurrent hernia) are some of the limitation of open Hernia surgery which led to the rapid popularity of Laparoscopic Hernia Surgery all over the world and in India. Laparoscopic Hernia Repair using small incisions offers rapid recovery, less pain and quick return to work.

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