Hernia & Minimally Invasive Surgery

Hernia and Minimally Invasive Surgery in AH focuses on providing comprehensive treatment for different types of abdominal wall hernia. Our multidisciplinary group of hernia specialists utilises a wide variety of surgical techniques including some advanced applications.

What is a hernia?

A hernia is a bulge over the abdominal wall caused by a weakness or tear of the muscles. This results in organs such as the intestines and fatty tissue inside the abdomen to protrude through the defect. Patients usually notice a swelling under the skin and may experience pain and discomfort occasionally. Symptoms may worsen after prolonged standing, walking or straining (e.g. lifting of heavy objects).

What are the different types of hernias that we treat?

Hernias are named according to their location on the abdominal wall or occasionally, their specific cause.

1. Groin Hernia: There are two types of groin hernias - Inguinal and Femoral. Inguinal hernia is the most common type of hernia and has two varieties - Indirect and Direct. Indirect hernia occurs through the groin in an area on the muscle where the male testis pierces and descends during foetal development. Femoral hernia is more common in women and is known to cause acute problems.
2. Umbilical Hernia: This is one of the most common hernias. Women are more commonly affected than men - likely due to a previous pregnancy. This area is particularly weak because of the umbilical cord attachment during birth.
3. Incisional Hernia: This form of hernia develops at the site of previous surgical incisions. The muscles around the incision site becomes weak and may lead to hernia formation. At times, multiple areas of weakness may develop with multiple hernias along the entire length of the scar and these can develop weeks, months or years after the initial surgery. Every subsequent surgery further weakens the muscle and increases the risk of hernia formation.
4. Midline Ventral Hernia: This can be epigastric (in upper abdomen), para-umbilical (around the umbilicus), supra-pubic (in lower abdomen) and sub-xiphoid (just below the rib cage in the midline).
5. Spigelian Hernia: This occurs through the spigelian fascia which is just beside the rectus muscles of the abdomen. The hernia lies in between two muscles of the abdominal wall and is hence difficult to diagnose clinically. The surgeon may need to perform an ultrasound or computed tomography (CT) scan.
6. Hiatal Hernia: This occurs when an organ, typically the stomach protrudes through the oesophageal opening in the diaphragm.
7. Rare Hernia: This includes lateral hernia, obturator hernia, lumbar hernia, sub-xiphoid hernia and parastomal hernia.

Treatment of hernia

Hernia can be diagnosed in most cases through a physical examination. In recurrent hernia, complex cases or in certain group of patients (e.g. obese, patient with previous surgery), an Imaging Diagnosis (Ultrasound, CT scan, MRI) may be necessary. Most hernias need to be repaired surgically to treat symptoms and prevent complications (e.g. strangulation of the intestine). Truss or abdominal binders are temporary measures for patients awaiting surgery or for very high-risk patients.

At the Alexandra Hospital, besides Open and Laparoscopic (Keyhole) Surgery, we perform surgical techniques such as Enhanced-view Totally Extraperitoneal (eTEP) repair for ventral and incisional hernia, Modified Totally Extra-Peritoneal (mTEP) repair of large groin hernia, Single Incision Laparoscopic (SILS) Hernia Repair, advanced local anaesthesia technique for groin hernia repair (NATURE) and Muscle Release surgeries such as Endoscopic Component Separation and Transversus Abdominis Release, among others.

Suitable treatment options are discussed with the patient after a thorough examination.