The layman once associated hernias (or ruptures, as they used to be known) with coughing, constipated old men who had urinary tract problems and strange swellings of the lower abdomen.
It was an unfashionable condition and there was almost a stigma attached to having a rupture. The problem wasn’t helped by regular advertisements in the Sunday tabloids for trusses to keep the rupture in check — these looked as if they could easily have been designed for a bondage club.
Although Sir Astley Cooper, the Victorian surgeon, said that a knowledge of the anatomy around hernias and skill in treating them was a good measure of the quality of a surgeon, his message has been lost down the ages.
Hernias are not confined to the old, poor, degenerate and destitute; they can occur at any age and in both sexes, although they are much more common in men. They are twice as common in newborn boys than girls — 4 per cent of boys and 2 per cent of girls are born with a hernia, and in later childhood they are nine times more common in boys.
In adults more than 20 times as many men as women develop hernias. They are most commonly a complaint of the middle-aged.
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The surgical repair of hernias has trundled along safely — though for the patient, not always comfortably or even successfully — for well over a century. But the calm of the surgical world in Britain was upset when, about 15 years ago, three well-qualified surgeons, all experienced in different aspects of surgery, were recruited by the newly founded British Hernia Centre in Hendon to do nothing except repair hernias.
The centre argued that hernia repair was a relatively simple operation and that doing it repeatedly would result in ever-increasing skill. The surgeons’ technique was bound to improve as they became super-specialists. Surprisingly, not even the London bombings last year stemmed the flow of cases from the United States.
The centre can operate on 90 per cent of hernias as day cases. The surgeons’ aim is for the the patient to be fit enough to ride an exercise bicycle within an hour of the operation (though they don’t really expect their patients to cycle home).
In fact the time that patients take to recover from a hernia operation varies considerably, but the average is two weeks before returning to work (six weeks if their job involves heavy lifting).
The advantage of going to the British Hernia Centre is this rapid return to normal. Whereas most people are in considerable discomfort for a fortnight, those attending the specialised unit have little post-op pain — the worst day is the third after surgery.
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Patients from the centre are encouraged to go jogging or to take a brisk walk the next day. Those who have surgery on a Monday, Tuesday or Wednesday should be able to play golf the next weekend.
An early return to work is not the only advantage. The recurrence rate is low — less than 1 per cent, even if the patient has had a hernia before, compared with the national average of 8 per cent. And less than 1 per cent of the centre’s patients have any form of post-operative complication such as bleeding, chest infections, thrombotic troubles or operative infections. The centre has never had a problem with MRSA (the hospital “superbug”) or a death.
Some of these advantages stem from the daycare system, the fact that the hospital is clean and uncontaminated by other, possibly infective, diseases, maximum use of local anaesthetics and the technique used by the surgeons — they have adopted the American system of using a mesh that is worked into the abdominal wall without any other stitching. The mesh strengthens the abdominal wall as tissue grows into it — it thus forms a scaffold rather than an adherent patch.
A hernia is the protrusion of the intestines through the abdominal wall, where they form a bulge that can be felt under the skin. The abdominal wall is composed of layers of muscles and tough fibrous tissue. It is nature’s corset, keeping the guts tucked safely into the peritoneal cavity.
Some areas of the abdominal wall are potentially weak. If the abdominal pressure rises, as happens when we strain through lifting, pulling or even repeated coughing, the intestines may be pushed through the wall. Usually the bulge can be pushed back again, but this gives only temporary relief.
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Complications occur when the intestines cannot be pushed back and become trapped in the hernial bulge. If the blood supply to the intestine is cut off by this, the patient’s life is at risk and emergency surgery is needed. Other hernias should be repaired as soon as possible.
Toes and feet: turn-on or turn-off?
Some 300,000 British men admit being foot fetishists but in two recent research studies, no woman confessed to being turned on by men’s feet.
When asked about toes, rather than feet, five million people in the UK admitted finding them attractive (as those infamous photographs of royal toe-sucking by a Texan served to illustrate).
Although men are more likely to be turned on by women’s feet than women by men’s, just 1 per cent of men enjoy having their feet stroked, whereas 3 per cent of women do.
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Besides being attracted by the obvious bits of others’ bodies, some people have interests such as elbows, knees or feet. And toes and feet certainly arouse emotions — 10 per cent of the UK population are so ashamed of their feet that they refuse to uncover them in public. So far as men are concerned this may be a wise decision, as one woman in ten finds smelly feet such a turn-off that she would exclude any man with them from her bed. In fact, most women would rather have a lover with greasy hair and dirty fingernails.
What can be done about foot odour? Well, besides washing the feet daily and changing shoes and socks frequently, the fungal infections that plague Western society and make feet scaly, itchy, unsightly and smelly should be cleared up.
A new preparation of Lamisil (terbinafine) has recently been introduced for over-the-counter sales. It is an effective fungicide; a treatment that not only inhibits and slows the spread of the fungus on toes and feet but actually kills it. Lamisil solution is applied once daily for up to four weeks.