The Hernia International Foundation and the Second Central Hospital recently organized the “Modern Trends in Hernia Surgery and Treatment” event in Mongolia for the 11th consecutive year. This ongoing partnership continues to play a vital role in advancing medical knowledge and surgical techniques within the country. During the event, we had the privilege of speaking with doctor Z.Sonor, a distinguished general surgeon at the hospital, who provided valuable insights into the risks, underlying causes, and preventative measures related to hernias. His expert commentary shed light on this common yet complex condition, offering a deeper understanding of both traditional and innovative treatment approaches.

The Hernia International Foundation and the Second Central Hospital have been collaborating for quite some time now. What is the main focus of this partnership?

Surgeons and specialists from countries that are members of the foundation visit Mongolia to conduct training sessions. The primary objective of these programs is to enhance the skills of our medical professionals. We also exchange experiences on the latest surgical techniques and developments in hernia treatment. This year, the training sessions took place at the hospital as well as in rural areas for a week each. The international doctors bring the necessary equipment and provide consultations and diagnoses on-site. 

They offer medical check-ups to individuals who, due to their location, do not have the access to travel to the capital city for treatment, thereby helping to mitigate potential future risks. This year, the focus was on laparoscopic hernia surgery. Additionally, we discussed new techniques, such as using botox injections to relax muscles in preparation for surgery.

How many specialists attended this time?

We had three surgeons from Australia and one professor from England. They spent a week sharing their knowledge with doctors in Govisumber Province. Following that, they conducted examinations, diagnoses, and treatments at our hospital, concluding with a series of training sessions.

The foundation gifted advanced laparoscopic surgery training equipment to hospitals. Does your hospital have similar equipment?

Most hospitals have older models of this equipment. However, we are now equipped with more advanced, state-of-the-art technology, including a new laparoscopic training device. This system allows for a realistic simulation of surgery, offering an immersive learning environment.

What are the primary causes of hernias?

A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. In simple terms, it’s when an internal organ protrudes through a part of the body where it shouldn’t. Hernias can be categorized into three main types: congenital, acquired, and postoperative. They can also manifest in various areas, including the abdominal and thoracic cavities. Essentially, a sac-like structure forms within the tissues, most commonly in areas where the abdominal muscles have weakened. A hernia occurs when these muscles stretch and fail to provide adequate support, allowing part of the intestine or other internal tissues to protrude. 

It’s dangerous to forcibly push or press a hernia back in, as this increases the internal abdominal pressure and may enlarge the hernia sac. In most cases, the hernia sac pushes through gaps in the muscle layers, allowing sections of the small intestine to slip through. Interestingly, the larger the hernia opening, the lower the risk. This is because when an organ enters the sac, it can more easily return through a larger opening. Conversely, a smaller opening is more dangerous and may lead to complications.

Moreover, congenital hernias are commonly found in children, particularly in the groin or scrotum areas. Acquired hernias, on the other hand, develop when muscle or tendon fibers weaken and allow internal tissues to protrude, often due to injury or strain. Excessive abdominal weight can also lead to hernias. In addition, during surgery, a small incision is made, and if it doesn’t heal properly, it can result in a post-operative hernia.

What are the most common symptoms and signs of hernias?

In many cases, hernias don’t cause significant discomfort initially. However, they often become more noticeable when the person is straining, such as during bowel movements, coughing, or sneezing. The symptoms can vary depending on the size of the hernia, and in some cases, they may develop without causing any discomfort until they become large. When this happens, a bulge may be visible on the abdomen, which can retract when lying down.

If a hernia causes pain or discomfort, it is crucial to seek medical attention and undergo surgery as soon as possible. Pain indicates that the hernia has become trapped and is unable to retract, a situation that requires emergency surgery. Delaying treatment can lead to severe complications, including strangulation of the intestines, which may result in tissue death and necessitate removal of the affected portion of the intestine.

Is surgery necessary after a hernia diagnosis, even if there is no discomfort?

A hernia may not cause pain in its early stages, but even if it only presents as a bulge in the body, there are still risks. Firstly, there’s the cosmetic issue, as the bulge can be unsightly. More importantly, if an organ becomes trapped in the hernia, it can lead to life-threatening complications. For instance, if the small intestine is pinched in the hernia, it can cause a blockage, cutting off blood supply to the tissue. This can result in necrosis (tissue death) and potentially life-threatening infections. So, even in the absence of symptoms, it is important to consult a specialist to evaluate the condition.

How is a hernia diagnosed?

If you notice a bulge or protrusion in your abdomen or any part of your body, it’s important to consult a specialist immediately. A surgeon can perform an initial examination to determine whether a hernia is present. If necessary, further tests, such as an MRI, will be conducted to examine the structure in detail. Depending on the location and type of hernia, we will decide whether surgery is required. Some patients may not need surgery immediately, but it’s essential to get a professional diagnosis.

Can hernias be fully treated in Mongolia?

Yes, hernias are fully treatable in Mongolia. As I mentioned earlier, hernias can occur not only in the abdominal wall but also in other internal organs. For example, diaphragmatic hernias occur when the opening that connects the esophagus and stomach enlarges, allowing the stomach to move upwards. All types of hernias can be treated here. The only definitive treatment is surgery. When a hernia grows larger and causes pain, surgery is performed to completely resolve the issue. 

For smaller hernias, doctors may recommend monitoring. Hernia surgeries can be done using either open or laparoscopic methods. Laparoscopic surgery has the advantage of causing less pain and allowing for quicker recovery. During surgery, the herniated tissue is pushed back into place, and the weakened area is reinforced with mesh to prevent recurrence. Simply stitching the hernia may risk reopening, which is why mesh is used as a permanent solution.

Is it true that hernias are more common in men than women?

While it’s often said that men are more prone to hernias, this is a bit of a generalization. In Mongolia, particularly among men, abdominal obesity is common. This increases internal abdominal pressure, and when there is a weak spot, the intestines or omentum can push through, leading to a hernia. Over time, the abdominal wall thins, and the hernia becomes more noticeable. Men are also more exposed to risk factors such as physical injury or unhealthy lifestyle habits like excessive alcohol or tobacco use, which can contribute to hernia development. For women, hernias are more likely to occur due to the stretching of the abdominal wall during pregnancy, which can weaken the area and lead to hernia formation.

At what age is hernia most commonly observed?

In the past, hernias were predominantly seen in older individuals, while cases in younger people were relatively rare. Congenital hernias were typically diagnosed and treated during childhood, whereas acquired hernias were more common among the elderly. As people age, the muscles and tendons in their body tend to weaken and lose function, making them more susceptible to hernias. This weakening leads to increased internal abdominal pressure, which is why hernias are more prevalent among older adults.

On the other hand, younger individuals tend to have stronger muscles and tendons, which reduces their risk of developing hernias. However, the risk of developing a postoperative hernia exists for individuals of all ages. After surgery, the stitches or incisions may come apart for various reasons, resulting in a hernia forming over the surgical wound.

What advice can you give for preventing hernia?

While it is impossible to prevent congenital hernias, there are steps one can take to reduce the risk of developing acquired hernias. For instance, maintaining a healthy weight and being cautious when lifting heavy objects—avoiding heavy lifting altogether if possible—is key. When lifting is necessary, it’s important to bend the knees and squat, rather than bending over from the waist. In general, adopting a healthy lifestyle can significantly decrease the likelihood of a hernia. Regular exercise is essential for keeping muscles strong, as muscles not only aid in movement but also act as a protective barrier against external forces. The stronger and more resilient the muscles, the less likely one is to suffer from a hernia.

When it comes to preventing postoperative hernias, the options are more limited, as the risk largely depends on surgical technique. For cases involving large incisions, surgeons often recommend wearing a support belt to aid recovery and prevent complications. It is crucial to wear this support belt consistently during the recovery period. In addition, limiting alcohol and tobacco consumption is vital. Smoking is known to trigger chronic coughing, which engages all the muscles in the body, including the abdominal muscles. Frequent and forceful coughing can weaken these muscles, increasing the risk of hernias or even reopening surgical wounds. Individuals who suffer from chronic cough, asthma, or other respiratory issues are also at greater risk of developing hernias. Therefore, managing respiratory health is another important aspect of hernia prevention.