Abdominal hernias: should they be operated on?

Surgery for inguinal and abdominal hernias can prevent strangulation, a major complication. Intervention techniques are evolving.

They can be caused by small congenital anomalies, pregnancy or violent and repeated efforts (chronic cough, carrying heavy loads, etc.). Abdominal hernias are like holes in the muscle wall through which viscera can enter. “We traditionally separate inguinal herniaslocated at the level of the groin, ventral hernias which pass through the line of the umbilicus”, says Dr. Philippe Ngo, visceral and digestive surgeon at the Hernia Institute in Paris. “The size of the orifice is variable, ranging from approximately 1 to 6 cm. The larger the hole, the larger the swelling or lump that will pop out. » Very common, this pathology can affect all ages of life, as Dr. Ngo reminds us. “It is estimated that around 10% of the population will have an inguinal hernia and 4 to 5% a ventral hernia, which makes, in France, between 200,000 and 250,000 patients operated on per year. »

Pain, burning, discomfort and bump or lump in the umbilicus or groin that appear when standing or during effort should alert and push to consult. Because the main complication of a hernia is strangulation. “Sometimes what comes out through this hole can get stuck or incarcerated, even strangled,” warns Dr. Ngo. “It is an emergency, because when the intestine gets stuck, if the blood no longer passes, the viscus can become necrotic. After a few hours, the tissue mortifies. »

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But the hernia is not always painful or large in size or even visible to the naked eye. “In the elderly with a small hernia that is not bothersome, we can avoid operating”, specifies the visceral and digestive surgeon. “But in most cases, the more time passes, the bigger the hole becomes with the risk that what comes out will be bulky and choke. » This risk for an inguinal hernia increases with its duration of evolution and would reach 30% in ten years, according to a 2002 study published by Pr Oberlin in the annals of surgery. Nearly 1 to 5% of the interventions would be carried out in emergency, the risk of strangulation increasing with the duration of evolution.

Ambulatory surgery

Two surgical techniques are now performed on an outpatient basis by laparotomy (incision of the skin and wall) or laparoscopy (examination by a mini-camera inserted into the abdomen). “Either we sew with a suture, or we put a very fine prosthesis or net to create a barrier in front of this hole”, says Dr. Ngo. Older, the first procedure can however be the cause of pain and recurrences.

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Conversely, the placement of prostheses behind the distended muscles, performed by endoscopy or using a mini-incision, seems more solid and conclusive. “A seam can come loose while the piece, if it is wide, forms a barrier, fixed by healing and no longer moves”, explains the practitioner. At the Hernia Institute, the technique, for ventral hernia, “in accordance with the principles of the French school of surgery”, passes through the placement of prostheses between the peritoneum and the muscle. “We no longer need to put a prosthesis inside the belly as is most often done, to avoid stapling pain and adhesions with the intestine, sometimes causing occlusions. » Recurrences are now less than 2%.


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