Hernia
What is a hernia?
A hernia (or "rupture") is a weakness or opening (defect) in the wall of the abdomen. This opening allows the contents of the abdomen to push outward causing a bulging, which is often seen against the skin. This bulge is the hernia. This weakness may be present at birth or it can be caused by the wear and
tear of daily living. Although men are more likely to have hernias, they also occur
in women and children. In fact, hernias are so common that people of any age can get them - even infants. Most hernias aren't life threatening, but treatment can help eliminate discomfort and prevent complications. It is estimated that about 10% of the population develops some type of hernia during life. More than a half million hernia operations are performed in the United States each year.
What are the signs and symptoms of a hernia?
Symptoms of a hernia include a bulge or swelling in the abdomen or groin area, which can also cause discomfort or pain. Your symptoms depend on the size and location of your hernia. Common symptoms include:
Why does a hernia occur?
Usually, there is no obvious cause of a hernia. The wall of the abdomen has several functions, and one is to provide support to the internal organs which push outward and create pressure against the abdominal wall. There are several natural weaknesses in this wall. The opening of a gap in tissue in these areas can occur on its own or it can happen if the tissue gets stretched. Activities, including the following, can put increased pressure on the abdominal wall and may cause a hernia:
• Chronic coughing
• Straining to urinate
• Heavy lifting
However, a hernia can also be caused by a simple sneeze.
What are the risk factors of not repairing a hernia?
If a hernia is not repaired, it may become trapped (incarcerated). When this happens, there is a danger that part of the intestine may become caught in the hernia cutting off blood supply to the area (strangulated). A strangulated hernia requires emergency surgery.
When should I call my doctor?
When you notice any of the signs and symptoms mentioned above, contact your doctor. However, not all lumps or swellings located in the abdomen or groin are hernias. It is important that the condition is properly diagnosed since it could be a groin strain or torn muscle.
Do hernias get better on their own?
A hernia does not heal on its own and there is no medical treatment to cure it. Over time, the hernia becomes worse - sometimes quickly. In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired.
How are hernias repaired?
The only way to stop a hernia from getting worse is to repair it surgically. If it is not repaired, there is a risk that emergency surgery at a later date may be needed.
Are there different types of hernias or are they all the same?
There are different types of hernias. The most common ones are described below:
Inguinal (Groin) Hernia
These are common in both men and women and appear as a bulge in the area of the groin. Groin pain along with a lump in the same area usually indicates an inguinal hernia. However, it is more common in men and the bulge may extend down to the scrotum. Men risk damage to their testicles if a hernia becomes strangulated. There are two types of inguinal hernias: indirect and direct. They form at or near a tunnel between the abdomen and the groin called the inguinal canal. Since these hernias form in the same area, your surgeon may not be able to determine which type you have prior to surgery. Regardless, your surgeon will be able to identify and repair either type during surgery. Your surgeon will talk to you about the best method to repair your inguinal hernia. A mesh device is used to make a tension-free repair. Over time, new tissue grows into the mesh. This will strengthen the repair and help prevent the hernia from recurring.
Umbilical Hernia
Another area of natural weakness where a hernia can occur is in the area of the navel (belly button). This is called an umbilical hernia and appears as a bulge at the navel. It occurs when the muscle around the navel doesn't close completely. The weakness in the abdominal wall can develop at birth or later in life. It is common in male and female adults and children. This type of hernia is often present at birth. Or, it can be caused by abdominal pressure from pregnancy, frequent coughing, being overweight, or other factors. Umbilical hernias were previously treated using a traditional suture repair. Now, a mesh device is used to make a tension-free repair, which is more comfortable after surgery and less likely to result in a recurrence.
Ventral Hernia
A ventral hernia occurs when part of the contents of the abdomen (bowel or intestine) stick out through a weakened part of the abdominal wall. This can result from previous surgery, heavy lifting, chronic coughing, severe vomiting, obesity, pregnancy, or diabetes. If the hernia occurs at or near where an old surgical scar was, then it is called an incisional hernia. However, ventral incisional hernias are often just referred to as ventral hernias. Any prior surgery of the abdomen can produce an incisional hernia. Whenever surgery of the abdomen is performed, an incision (cut) is made in the abdominal wall and later sutured (sewn) together. Over time, a hernia tends to develop in these weakened areas. It can be caused by infection or the operation itself whether it is a large abdominal surgery or a small incision as with an appendectomy. While these can occur at the incision, they are more commonly seen along a straight line running vertically (up and down) from the breastbone straight down to the pubic bone. Incisional hernias in this area are among the most frustrating and difficult hernias to treat. To prevent the hernia from returning, a tension-free repair method using mesh (synthetic material) is used. The most common symptom of an incisional hernia is a bulge or knot that forms beneath the skin near a scar.
Femoral Hernia
A femoral hernia may be seen as a painful lump or bulge in the upper part of the thigh near the groin. Femoral hernias tend to occur more often in women than in men. Most femoral hernias cause no symptoms. There may be some groin discomfort that becomes worse when you stand, lift heavy objects, or strain. Surgery will relieve discomfort. Also, if the hernia is not treated, there is a risk of tissue getting stuck or trapped in the weak area (called incarceration). Sometimes, the first symptoms are abdominal pain, nausea, and vomiting. This may mean that the intestine is blocked, which is an emergency since the tissue may die off if it remains incarcerated for too long.
What would happen if I don't get my hernia repaired?
There are several complications that can occur if a hernia is not treated including:
I've read that mesh is used to help repair a hernia. What is it and how does it work?
Mesh is a surgically designed, sterile woven material. There are many types of mesh products available, but surgeons typically use a sterile, woven material made from a synthetic plastic like polypropylene or some other such synthetic material. The mesh can be in the form of a patch that goes under or over the weakness, or it can be in the form of a plug that goes inside the hole. Mesh is very sturdy and strong, yet extremely thin. It is also soft and flexible to allow it to easily conform to body's movement, position, and size. Mesh acts as "scaffolding" or like a bridge for new growth of a patient's own tissue, which eventually incorporates the mesh into the surrounding area. The mesh decreases the tension on the weakened area, reducing the risk that a hernia will recur. Surgeons select the specific mesh that will be most effective for the particular operation and best suited to the patient's condition.
What types of surgery are used to repair a hernia?
It is estimated that approximately 600,000 hernia repair operations are performed annually in the United States. There are two types of surgical approaches that can be used in hernia repair operations - "open" and "laparoscopic". Many hernia repair operations are performed by the "open" conventional method. In an open hernia repair, your surgeon makes an incision to open the abdominal cavity and repairs the hernia from this incision. However, some hernia repairs are performed using a small telescope known as a laparoscope and other specialized instruments. This type of surgery is called laparoscopic surgery and is also referred to as "minimally invasive" surgery. It's been called minimally invasive surgery, and with good reason. Surgeons combine the best of modern technology to perform operations in the abdomen and pelvic cavities involving smaller incisions that allow your doctor to perform the same vital tasks as traditionally done in open abdominal surgery. Laparoscopic procedures use both smaller tools and a video camera to guide the surgeon when making delicate incisions. The technique can be used in almost every type of abdominal surgery.
The enhanced visual field for the surgeon, the shortened recovery times, along with reductions in possible complications, combine to provide a safer experience for the patient. As with any surgical procedure, there are risks and you should talk with your surgeon so you have a better understanding of its application to your problem. This way you and your surgeon can make an informed decision.
What is the difference between open and laparoscopic procedures?
Use of laparoscopic techniques promotes early recovery, and reduced complications like adhesions and hernias. Laparoscopic surgery, sometimes called keyhole surgery, also reduces the amount of pain when compared to open surgery where major, long incisions are required. By allowing the patient to breathe easier and deeper after the procedure, a laparoscopic approach reduces the chance of pneumonia, atelectasis, which is a collapse of air sacs in the lungs, and respiratory failure. In addition to reduced pain, surgery performed this way permits the patient to be up and about sooner. This reduces the chances of complications like deep vein thrombosis (blood clots in the legs) and pulmonary embolisms (blood clots in the lungs). The patient can usually return to normal functions in as little as two weeks compared to four to six weeks after open surgery.
Is laparoscopic repair for everyone?
Options for the type of surgical approach should be reviewed your surgeon. Based on a thorough examination along with your medical history, your surgeon can help you decide whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or have underlying medical conditions.