Dr. Deyan Lazarov on hernias – types, symptoms, treatment, and the possibility of free examinations at Hera Medical Center

Dr. Lazarov, what is a hernia of the abdominal wall?

The abdominal wall is made up of several layers of muscles and other types of tissue that support human movement and protect internal organs. A hernia represents a defect in the abdominal wall through which parts or even whole organs from the abdominal cavity can pass, remaining covered only by the skin. Hernias typically form somewhere along the abdominal wall or in the groin. They appear as bulges that come and go with different movements and activities. For example, they may appear when coughing or straining and disappear when lying down. They can cause symptoms such as discomfort or pain, but a person may also have no complaints at all. Overall, hernias are a very common condition – over 25% of men develop an inguinal hernia during their lifetime.

What are the most common types of hernias?

• Inguinal hernias: These occur when fat tissue or a portion of the intestine passes through the abdominal wall in the area of the groin and upper inner thigh. This is the most common type of hernia and primarily affects men. It is often associated with aging and repeated strain on the abdomen.
• Femoral hernias: Similar to inguinal hernias, femoral hernias are located in the upper part of the inner thigh. They are much less common and affect more women than men.
• Umbilical hernias: These occur when fat tissue or a portion of the intestine protrudes through the abdominal wall near the belly button. They result from repeated strain, after pregnancy, or due to obesity.
• Incisional hernias: Formed in the area of a surgical incision in the abdomen that has not fully healed (following other surgeries).
• Epigastric hernias: Formed between the belly button and the lower part of the breastbone.

There are also other rarer types of hernias, as well as those not on the abdominal wall.

What are the predispositions for the occurrence of a hernia?

Hernias form in areas where there is naturally a weakness in the abdominal wall. This weakness may be present from birth or develop over time. Causes that can lead to weakness or defect in the abdominal wall include past surgeries, repetitive strain, trauma, and others.

You are more likely to develop a hernia if:

• Your work involves heavy lifting;
• You have chronic coughing;
• You have chronic constipation;
• You have had abdominal surgeries;
• After multiple pregnancies;
• You are obese (body mass index/BMI over 30);
• You have other diseases or conditions associated with connective tissue weakness – such as varicose veins, haemorrhoids, etc.

How is the condition diagnosed?

A physical examination is usually sufficient to diagnose a hernia. The surgeon may examine the patient in different positions or have them cough. If the hernia does not reduce spontaneously, they will attempt to reduce it manually. In some more specific or complex cases (such as patients who have undergone multiple surgeries), imaging studies of a specific area may be necessary – such as magnetic resonance imaging (MRI) or computerized tomography (CT).

Can a hernia disappear on its own?

Hernias do not improve over time. Most hernias require surgical treatment (operation). Hernias do not heal on their own; instead, they tend to increase over time and can lead to potentially life-threatening complications. Larger and older hernias are also more complex to treat.

What symptoms should prompt a patient to seek help from a surgeon, and is that the right specialist to book an appointment with?

You should visit a doctor if you suspect you have a hernia. A surgeon is the specialist who deals with this condition. They can both diagnose and treat it. Of course, you may first visit your primary care physician, and if hernia is suspected, they will refer you to a surgeon.

The symptoms depend on the type of hernia, and in some cases, there may be almost no complaints. You may consider a hernia if you have:

• Visible swelling under the skin of the abdomen or groin. It usually appears when standing or straining and disappears when lying down.
• Heaviness in the abdomen or at the site of the suspected hernia.
• Discomfort in the abdomen or groin, especially during exertion.
• Sensation of burning or pain at the site of swelling.
• Shooting pains in the area of swelling of the abdominal wall.

Emergency medical attention should be sought if (indications of strangulation):

• Inability to reduce a previously known hernia, which has become firm and painful.
• Appearance of a firm and painful swelling in the groin, accompanied by general discomfort. Nausea and vomiting may occur.

What complications can a hernia lead to?

A hernia may never cause any complaints for the patient, but hernias tend to enlarge over time. The opening in the abdominal wall continues to weaken over time, stretch, and more and more abdominal contents pass out towards the hernia. When the hernia becomes large, some of the functions of the abdominal wall are disrupted – protection of internal organs, participation in movement, and breathing. When part of the intestine becomes trapped in the hernia, it can disrupt their function, leading to periodic pain, abdominal swelling, and difficulty with bowel movements.

In most cases, complications start when the hernia becomes incarcerated and cannot be returned back. If there is a strangulated intestine, obstruction develops, and food and gases cannot pass through – this is called ileus. If the strangulation leads to a disruption in the organ’s blood supply, it can result in tissue death (necrosis or gangrene), with subsequent peritonitis.

How does the surgery happens?

Surgical treatment to repair a hernia is a very commonly performed procedure. Typically, the contents of the hernia are returned back into the abdominal cavity, and the defect in the abdominal wall is repaired and often reinforced with mesh. Depending on the type of hernia and the surgical approach, general or local anaesthesia may be used.

In most cases, minimally invasive (laparoscopic) methods can be used for routine hernia repair, which means smaller incisions, less postoperative pain, and faster recovery. However, some types of hernias may require a traditional open surgery approach.

How long does the patient’s recovery take?

Recovery depends on the type of hernia and the surgical approach. Typically, the patient can stand and walk on the same or next day after surgery. After minimally invasive (laparoscopic) surgery, recovery is very fast, and patients can resume running and sports within a few days.

Once a hernia is repaired, can it reoccur?

It is possible for a hernia to reoccur (recur) after it has been repaired – either shortly after the surgery or later on. With modern treatment methods, the risk of recurrence is less than 1%. Several factors can increase the risk of hernia recurrence – age, accompanying diseases, the size and type of hernia before surgery, failure to follow the surgeon’s recommendations, etc.

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If you suspect you have a hernia, consult a surgeon and follow their recommendations before complications arise. Don’t be afraid of the surgery – these are among the most commonly performed procedures worldwide and can significantly improve your quality of life. On March 30th and April 20th, 2024, Dr. Lazarov will be conducting free examinations for patients with hernias at the Medical Center Hera in Sofia. You can schedule an appointment for either date now using the following methods:

• By phone: 02 404 8656; 0882 441 433 or 0883 447 135
• Via Superdoc platform: https://superdoc.bg/lekar/deyan-lazarov
• e-mail: contact@drlazarov.com
• Dr. Lazarov works with NHIF.