General Surgical Problems

A hernia occurs when intraabdominal fat or bowel protrudes through a defect in the muscles which make up the wall of the abdomen.  The abdominal muscles usually keep all the organs and internal tissues in place. However, sometimes, a weak spot can form in the muscles, and a hernia can occur. This will result in a bulge appearing in the abdomen, or groin, which can occasionally feel painful, particularly when bending, or lifting.  A hernia can occur anywhere in the abdomen region. The most common types of hernias are as follows and the general whereabouts of the types of hernia indicated on the diagram:

Inguinal hernias
Inguinal hernias are the most common type of hernia. Every year in England, 70,000 surgical operations are required to repair inguinal hernias.  In all reported cases of inguinal hernias, 98% occur in men. Inguinal hernias can occur at any age.

Femoral hernias
Femoral hernias are less common than inguinal hernias, occurring in 16 out of every 100,000 people in England. Around 75% of cases of femoral hernias occur in women.

Incisional hernias
Incisional hernias develop as a consequence of previous abdominal surgery. The chance of an incisional hernia developing after surgery can vary from between 0.5%-10%, depending on the type of surgery involved.

Umbilical/paraumbilical hernias
These hernias are very common, especially in young children, with as many as 1 in 6 children being affected.  Many cases will resolve as a child grows older, without the need for treatment. However, adults can present with new or persistent paraumbilical hernias and these can be treated with an open mesh hernia repair.

Epigastric/ventral hernias
These hernias are three times more common in men than in women and are most likely to occur between 20 and 50 years old.

Treatment usually involves surgery to treat a hernia of the abdominal wall that is painful or cannot be pushed back into place.  A strangulated hernia in which the blood supply to a trapped portion of the intestine is cut off requires emergency surgery.  During surgery, the protruding intestine is pushed back into the abdomen and the weakened muscle wall strengthened.  Either open or laparoscopic techniques may be used and usually mesh reduces the incidence of recurrence. 

Gallstones are lumps of solid matter that develop in the gallbladder. Most gallstones are made of cholesterol and bile pigments from the breakdown of red blood cells.

Gallstones are more likely to occur if your bile contains too much cholesterol, if the outlet from your gallbladder is blocked, or infected, or if you have a family history of gallstones.  Gallstones can be a variety of shapes. They can be round, oval, or faceted and usually occur in the gallbladder but may enter the bile duct. Most gallstones are usually about the size of a pea but, in some cases, they can be much smaller, like fine gravel. Sometimes, gallstones can form into a single stone so large that it completely fills the gallbladder.

If gallstones are detected, treatment is only needed if gallstones are symptomatic. Symptoms include right upper abdominal pain, indigestion & bloating, nausea and vomiting and jaundice.

Gallstones are normally treated by surgically removing the gall bladder in a procedure known as a cholecystectomy. The procedure uses laparoscopic surgery that is sometimes known as 'keyhole' surgery.  However, sometimes it is not possible to remove the gallbladder using keyhole surgery, and about 5% of people need to have an open cholecystectomy, where the gallbladder is removed through a larger incision in the abdomen.

A pilonidal sinus is a hair filled track in the natal cleft between the buttocks. It may discharge blood or fluid and become painful or recurrently infected.

Treatment may include wide excision and packing of the area), excision and primary suture or by plastic surgery using skin flaps to reconstruct the area. They can be a challenge to heal postoperatively and often can recur.