Hongkong Hernia Centre

Frequently Asked Questions

What is a hernia? What signs and symptoms do hernias cause? What do hernias contain? Are there different types of hernia? Which hernias occur in the midline of the abdomen? What is an incarcerated or strangulated hernia? In whom do hernias occur? Do hernias occur in pregnancy? Do I need an operation? Do I need to see the surgical specialist first before considering an operation? What is informed consent? How long would I be in hospital? Will I need a local or general anaesthetic? Who would look after me? How is my operation made as safe as possible? Who would perform my operation? Do I need to worry about keeping the dressing dry? Do I need sutures removed?


What is a hernia? top

A hernia is simply a defect, weakness or rupture of an area of the muscular wall of the abdominal cavity.  The lining of the abdominal cavity (the peritoneum) is pushed out through the defect or weakness forming a hernial sac. The hernial sac is often responsible for the presence of a swelling.  The sac may contain a small amount of fluid, the omentum (the fatty apron in the abdominal cavity) or part of the intestines. Often there is no obvious reason (such as in children) why hernias develop except for advancing age with loss of the vital collagen component in the tissues of the abdominal wall which is needed to preserve the status quo.
Contributory factors leading to the development of a hernia:

  1. Advancing age

  2. Chronic cough

  3. Strains playing sport

  4. Difficulty passing urine

  5. Pregnancy Constipation

  6. Obesity

What signs and symptoms do hernias cause? top

Often hernias cause neither.  The weakness may be present for many months or years before it becomes apparent.  For example, during pregnancy a small umbilical hernia may appear and then disappear after the end of pregnancy.  Often there is a reducible swelling which disappears when patients lie down and becomes very obvious when they stand up.  In some patients who have had a long-standing hernia, the swelling may not disappear when they lie down.  There may be discomfort, pain, a dragging sensation or localised tenderness where the hernia appears.  If a hernia becomes strangulated and stuck, there may be symptoms of bowel obstruction with vomiting, severe colicky pain, abdominal bloating and marked tenderness over the hernia.

What do hernias contain? top

This depends on where the hernia is sited.  Those arising in the midline often contain fatty tissue arising from the preperitoneal layer outside the peritoneal cavity.  If there is a well formed hernial sac, then it may contain omentum (part of the fatty apron that everyone has inside the abdomen).  Hiatus hernias contain part of the stomach and usually little else.  In groin hernias, the hernial sacs may contain the parts of the omentum, small bowel, colon, urinary bladder, appendix, or ovary.  If operation becomes necessary, then your specialist needs to be aware of these when performing the dissection of the sac and its contents.

Are there different types of hernia? top

Yes.  The commonest type requiring repair is an inguinal hernia found in the groin region.   Femoral hernias are also found in the groin.  Umbilical hernias occur in the umbilicus, whereas paraumbilical hernias are found beside the umbilicus.  Where there are small defects in the fibrous tissue joining the abdominal muscles in the midline above the umbilicus, epigastric hernias can appear.  If the abdominal muscles broadly separate in the midline to cause a diffuse bulge, this is termed a divarification of the rectus muscles.  Spigelian hernias are rare and occur at the edge of the rectus muscles.  If you have had a previous operation on the abdomen, a swelling which forms through the old wound is called an incisional hernia.  If the stomach partially migrates into the chest, a hernia will form where the gullet enters the stomach.

Which hernias occur in the midline of the abdomen? top

The linea alba is the midline raphe of fibrous tissue formed by the junction of the rectus sheaths which contain the rectus muscles  (the ‘six packs’).  Defects or weaknesses can occur anywhere along its length.  Above the umbilicus the defect in the linea alba may be small giving rise to an epigastric hernia, or large where the whole of the linea alba becomes attenuated giving rise to a divarification of recti.  Defects at or around the umbilicus, may give rise to paraumbilical or umbilical hernias.

What is an incarcerated or strangulated hernia? top

When the contents of a hernia sac cannot be reduced to empty the sac because adhesions have formed between the contents of the sac, or the large volume of the contents does not allow it to fall back into the abdomen, the hernia is non-reducible or incarcerated.  Where the blood supply to the contents of the sac is compromised then the hernial contents have become strangulated.  This may occur for example, where the bowel has become twisted inside the hernial sac.  When strangulation occurs, urgent surgery is needed.

In whom do hernias occur? top

Hernias occur in both sexes and at any age.  Certain types of hernia are more common in males (such as inguinal hernias for example) or in females (such as femoral hernias).

Do hernias occur in pregnancy? top

Yes.  Because the pregnant uterus raises the intra-abdominal pressure, the common sites for hernias to appear are at the umbilicus, and in the groin (inguinal and femoral).  Fortunately they infrequently cause sufficient symptoms to warrant urgent surgery but the dragging discomfort experienced particularly in the groin hernias may necessitate semi-urgent surgery.  Surgery, if needed during pregnancy should be deferred for as long as possible because of the inherent risks to the baby, preferably into the third trimester.  After birth, umbilical hernias tend to reduce considerably and need not necessarily be repaired as they cause few symptoms.  However, inguinal and femoral hernias should be repaired electively because of the inherent risks of enlargement and  strangulation

Do I need an operation? top

Not always.  Some hernias will close naturally after a period of time such as those present at birth i.e. at the umbilicus.  Others may be very small and not cause symptoms.  Hiatus hernias often do not require surgery because effective medical treatments are available to control symptoms.  On the other hand, groin hernias at any age should be repaired because of the substantive risk for the intestines or other organs to become trapped and / or strangulated in the hernial sac.

Do I need to see the surgical specialist first before considering an operation? top

Yes.  You may have already seen your own family practitioner who has diagnosed your hernia.  It is important for you to consult the surgical specialist so that a detailed history and examination of your hernia is documented. The specialist will determine whether you have any other medical problems which may complicate your treatment.  The specialist will provide you with a diagnosis, information on your type of hernia and the treatment options which are available.
If you are flying in from China or another regional country with a pre-arranged admission, the initial consultation will occur on the day prior to planned surgery to ensure that an operation is the most appropriate form of treatment.

What is informed consent? top

This is the process by which your doctor will discuss the nature of an investigation, medication, treatment, or procedure with individual patients to inform them of the benefits expected whilst also explaining the potential risks.  Your doctor must explain these to you before you consent to a procedure.

How long would I be in hospital? top

For most hernia operations, patients are admitted on the morning of surgery and discharged either the same day or the next day.  Longer stays are necessary where marked discomfort persists or where the patient cannot undertake normal activities.

Will I need a local or general anaesthetic? top

Most of the hernia operations would be conducted under general anaesthesia by an anaesthetist who is a Fellow of the Hong Kong Academy of Medicine.  The anaesthetist may give you premedication to calm you prior to surgery.  If you have a strong preference for your operation to be conducted under local anaesthesia, this may be discussed with your surgeon at the initial consultation.  If surgery is needed in patients who are pregnant and have a symptomatic hernia particularly in the first two trimesters of pregnancy then local anaesthesia is strongly recommended.

Who would look after me? top

Your specialist will see you prior to surgery, answer any last minute questions that you may have and mark the site of your hernia.  They will visit you again on the evening after surgery and the following day or until discharge.  The hospitals utilised provide the highest possible standards of clinical care and employ internationally trained, bilingual staff.

How is my operation made as safe as possible? top

When you arrive at the ward, the nursing staff will complete a comprehensive questionnaire of medical history and check your respiratory and pulse rates, blood pressure and temperature.  If you have a cold or other illness, please call your specialist before you come to the hospital to seek advice.  It may be more appropriate to allow you to fully recover before having your surgery.  Surgery is very safe and all necessary precautions are taken.  Clinical guidelines are used for ward and theatre care.  Early mobilisation, special medication and support stockings are used to prevent blood clots.  Clinical practices are monitored.

Who would perform my operation? top

This will be the same specialist who saw you for the initial consultation.

Do I need to worry about keeping the dressing dry? top

No.  In most patients, an Opsite adherent dressing will be used.  This has the advantages of allowing the wound to breathe and yet being waterproof.   The dressing can therefore be used with showers or baths but prolonged soaking is not recommended.  There is also no need to change the dressing as it will usually remain intact until you have been seen at your follow-up consultation 7-10 days after your operation.

Do I need sutures removed? top

No. In most patients, a subcuticular stitch will be used which will dissolve under the skin.  The wound will be supported by butterfly dressings which will remain in place for up to 4 weeks after surgery, to minimise the stretching of the wound.