Abdominal Hernias

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the fascia, the strong layer of the abdominal wall that surrounds the muscle.

The types of hernias are based on where they occur:

• Femoral hernias appears as a bulge in the upper thigh, just below the groin. This type is more common in women than men.
  
• Incisional hernias can occur through a scar if you have had abdominal surgery in the past.
  
• Inguinal hernias appears as a bulge in the groin. This type is more common in men than women. The bulge may go all the way down into the scrotum.
  
• Umbilical hernias appears as a bulge around the belly button. It occurs when the muscle around the navel doesn’t close completely.

Causes, incidence, and risk factors

Usually, there is no obvious cause of a hernia. Sometimes hernias occur with heavy lifting, straining while using the toilet, or any activity that raises the pressure inside the abdomen. Hernias may be present at birth, but the bulge may not be noticeable until later in life. Some patients may have a family history of hernias.

Any activity or medical problem that increases pressure on the abdominal wall tissue and muscles may lead to a hernia, including:

• Chronic constipation, straining to have bowel movements
  
• Chronic cough
  
• Enlarged prostate, straining to urinate
  
• Extra weight
  
• Fluid in the abdomen (ascites)
  
• Heavy lifting
  
• Peritoneal dialysis
  
• Poor nutrition
  
• Smoking
  
• Overexertion

Symptoms

Most often there are no symptoms. However, sometimes there may be discomfort or pain. The discomfort may be worse when you stand, strain, or lift heavy objects. In time, most people will complain about a growth that feels tender and is growing.

Although a hernia may only cause mild discomfort, it may get bigger and strangulate. This means that the tissue is stuck inside the hole and its blood supply has been cut off. If this occurs, you will need urgent surgery.

Signs and tests

Our surgeons can confirm that you have a hernia during a physical exam. The growth may increase in size when you cough, bend, lift, or strain.

In some cases, an ultrasound may be needed to look for a hernia. If you may have a blockage in your bowel, you will need an x-ray of the abdomen. CT scans are also very useful for finding some hernias.

Treatment

Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for patients with serious medical problems. If the hernia is small and not causing symptoms, your surgeon may just need to watch it to make sure it is not growing or causing problems.

Surgery will usually be used for hernias that:

• Are getting larger
  
• Are painful
  
• Cannot be reduced without surgery
  
• May involve a trapped piece of bowel

Surgery secures the weakened abdominal wall tissue (fascia) and patches closed any holes. Today, most hernias are closed with plastic patches to plug up the holes.

Emergency surgery is sometimes needed. The sac containing the intestine or other tissue may become stuck in the hole in the abdominal wall. If it cannot be pushed back through, this can lead to a strangulated loop of intestine. If left untreated, this portion of the intestine dies because it loses its blood supply.

Today, hernias can be fixed by open surgery or by keyhole (laparoscopic) surgery. MUGISG surgeons are experienced in performing both types of repair. The advantages of using a camera include smaller surgical cuts, faster recovery, and less pain after the procedure.