Hernia

Overview

A hernia is a small sac containing abdominal tissue which protrudes through an opening in the muscles of the abdominal wall. This opening can be a result of congenital defect (an opening which you were born with) or may be an acquired flaw due to stress on the abdominal muscles.

Hernias most often occur in or near the groin, abdomen, navel or previous sites of abdominal surgery. Left untreated, a hernia will generally increase in size and become more painful. It can lead to more serious, life-threatening complications.

Any part of the abdominal wall can develop a hernia, however, the most common site is in the groin area (inguinal hernia). With an inguinal hernia, the sac protrudes into the groin and sometimes the scrotum. Ventral hernias occur in the abdominal wall and some types include umbilical, epigastric and incisional hernias. Umbilical hernias occur through the naval area, femoral hernias occur in the lower groin area and incisional hernias occur through old surgical scars.

There are many different types of hernias:

  • An abdominal wall hernia is a weakness or tear in the abdominal muscles that allows fatty tissue or an organ (such as the intestines) to protrude through the weak area. Although more common in men a hernia can develop in anyone - from a newborn baby to older adults.
  • An inguinal hernia is the most common type of hernia, affecting about 2% of men in the U.S. Men are more susceptible to this type of hernia because of a potentially weak spot in the groin (known as the "internal ring").
  • ventral hernia occurs in a weakened area of the abdominal wall.
  • An epigastric hernia occurs as a result of a weakness in the muscles of the upper-middle abdomen (above the navel). Three times more men than women develop epigastric hernias with the majority occurring in people between the ages of 20 and 50.
  • femoral hernia, which occurs in the area between the abdomen and the thigh, is usually the result of pregnancy and childbirth and is more common among women.
  • An incisional hernia can occur at the site of an incision from a previous surgery when fat or tissue pushes through a weakness created by a surgical scar. These can develop weeks, months or years after the initial surgery.
  • An umbilical hernia can occur in the naturally weakened area of the navel where the umbilical cord was attached and the tissue is thinner than the rest of the abdomen. Umbilical hernias can occur in babies, children and adults.

Causes

A hernia occurs when the layers of the abdominal wall weaken. The inner lining of the abdomen pushes through the weakened area to form a balloon like sac. A loop of intestine or abdominal tissue can then slip into the sac. This causes a bulge which can be seen or felt on exam.
 
Hernias may result from sudden or repeated strain or stress on the abdominal muscles. Other hernias are congenital openings (which you are born with) that never fully closed at birth.
 
Types of activity typically associated with hernias include: 
  • Lifting heavy objects
  • Sudden twists, pulls or muscle strain
  • Chronic straining with urination
  • Chronic constipation
  • Repeated coughing attacks

Other risk factors for developing a hernia include: a chronic cough, obesity, pregnancy, and persistent sneezing.

 

Symptoms

You may experience any of the following symptoms:

  • A noticeable protrusion in the groin or abdominal area
  • Feeling pain while lifting
  • A dull aching sensation
  • A vague feeling of fullness

Treatments

There are several different techniques used in hernia repair. Your surgeon will discuss these techniques with you and use the technique best suited for your situation.

Inguinal Hernia (Groin) Repair

  • Open Repairs- a small incision is made in the groin and the repair is performed from the “front”. This is typically outpatient surgery.
  • Laparoscopic Repairs - small incisions are made in the lower abdomen and the repair is made from the “inside”. This is typically outpatient surgery.

Ventral Hernia (Abdominal) Repait

  • Open Repairs - a small incision is made above the hernia and the repair is performed from the “front”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.
  • Laparoscopic Repairs - small incisions are made in the abdomen and the repair is made from the “inside”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.

Complex Ventral Hernia Repairs (Abdominal Wall Reconstruction)

  • Some patients will have hernias which require advanced techniques to repair. Very large or multiple hernias are often challenging to repair. Hernias associated with infection risk (obesity, diabetes, smoking, prior wound infection, etc.) are also complex.
  • A technique referred to as "component separation" is used for larger and more complex hernias. The hernia is repaired by moving the patient's own muscle and abdominal tissue together to repair the hernia. The hernia is repaired by closing the defect with the patient's own tissue and a mesh is used to reinforce the repair. This leads to a more functional long term repair. This technique requires inpatient surgery.

Using Mesh

  • Hernia repairs were traditionally performed using a series of sutures to close the hernia opening. This type of repair has a very high failure rate and has been abandoned by most hernia repair experts. Modern hernia repairs use a reinforcing “mesh” to give the repair strength and durability. Mesh comes in two broad categories: synthetic and biologic.
  • Synthetic mesh is made from a variety of products including sterile plastics, gortex, and polyester. These are permanent implants that the body incorporates into the repair. Biologic mesh is derived from animal and human collagen tissue. These products are incorporated into the repair and are slowly remodeled into the patients own tissue.