Abdominal wall hernias occur when an organ or tissue protrudes through a weakening in the front abdominal wall. The abdominal muscles and surrounding tough tissue normally hold the abdominal contents in place. The lining of the abdominal cavity (peritoneum) is pushed by organs or intra-abdominal tissues like a sac or a balloon which often becomes visible. Majority of hernias occur in the groin, either as inguinal or femoral hernia.
Epigastic hernia is a hernia that develops anywhere in the midline and above the belly button (umbilicus) and below the breast bone.
Umbilical hernia is hernia that develops at the level of umbilicus (belly button).
Inguinal hernia is a hernia that develops in the inguinal canal. The inguinal canal is an area of the abdominal wall that allows the spermatic cord and testicle to descend from the abdomen into the scrotum as the fetus develops and matures. In females this area contains round ligament of the ovary.
Femoral hernia is a that develops through the weaker area where the femoral vessels and nerve (going to the leg) leave abdomen and go into the leg.
Spigelian hernia is very rare and occur on the outside edges if the rectus abdominis muscle.
Incisional hernia develops as a complication from abdominal surgery at the site of previous incision. All surgeons repair and close the incision, this area is always weaker than the normal abdominal wall and more susceptible for development of hernias.
Risk factors for developing hernia are: chronic constipation, chronic cough, recurrent vomiting, obesity, ascites (collection of fluid inside the abdominal cavity), dialysis, abdominal masses, pregnancy, previous surgeries and repeated heavy lifting.
Hernias may be asymptomatic (not causing any problems) or they can cause abdominal pain and discomfort. The other, more serious complication is if organ becomes caught in the hernia and cannot be pushed back. The tissue that is caught can die. If this happens to bowel, the dead part will perforate (make a hole) and patients develop septicaemia.
If hernias are asymptomatic, they may not need any treatment. If they are symptomatic, then they need to be repaired. Also symptoms like constipation or abdominal masses need to be investigated prior to repair.
There are 2 types of surgical repair: open and laparoscopic repair.
In open repair the surgeon often makes the incision at the site of the hernia. The protruding tissue is pushed back into abdominal cavity and weakened area (defect in the abdominal wall) stitched. A piece of mesh may be placed into the area to prevent hernia. In open inguinal hernia repair the mesh is almost always used. In other types of surgery mesh is used less.
In the laparoscopic repair the hernia is reduced (pushed back into the abdominal cavity) and mesh is always inserted to close the defect in the abdominal wall. It is not possible to perform laparoscopic repair without the mesh.
The complications of hernia repair are rare.
Hernia recurrence – inguinal less then 5 %, others up to 10%.
Infection (less then 2%)
Scarring
Chronic pain
Damage to blood supply to testicle.
Damage to bowel