Introduction
This is information about hernia (rupture), including how hernias occur and how they are repaired. If you still have questions please ask your doctor for more information.
What are hernias?
A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period. If the defect is large enough, abdominal contents such as the bowels may protrude through the defect causing a lump or bulge felt by the patient.
What types of hernia are there?
The most common type is the groin or inguinal hernia. Herniae may also occur through the umbilicus (umbilical hernia), through old abdominal scars (incisional hernia), through the muscles in the upper abdomen (ventral hernia) or alongside blood vessels running into the thigh (femoral hernia). There is also Hiatus hernia, which is often associated with Gastro-esophageal reflux disease.
Laparoscopic repair is mainly used for hiatus, inguinal, ventral & incisional hernia repairs.
The abdominal wall is made up of 3 interwoven sheets of muscle. Although very strong, points of weakness do exist, especially in the groin and around the umbilicus (belly button), and along previous surgical incisions.
If stressed, these weak points may allow a sac of the abdominal lining (the peritoneum) to push through the defect. The hernial sac may be empty or may contain part of the abdominal contents, commonly intestine.
Inguinal hernia
There are two types on inguinal hernia. The direct type is more common and usually occurs because of a weak spot in the abdominal muscles leading to a visible bulge in the groin area. The second type is the indirect type, which goes down the inguinal canal into the scrotum.
Umbilical and Paraumbilical Hernias
These occur when some tissue pushes through the abdomen near to the belly button (umbilicus). Umbilical hernias can be present from birth and in most cases the hernia goes back in and the muscles re-seal on their own before the baby is 1 year old. They will generally be repaired if they persist beyond 5 years of age or if they are very large.
Umbilical hernias may develop in adults with being overweight (obesity) and excessive accumulation of fluid within the peritoneum of the abdomen. The peritoneum is a lining of the abdomen and consists of two layers, one which lines the abdominal wall and the other which covers the organs in the abdomen.
Paraumbilical hernias occur in adults and appear above the umbilicus. Although they are generally small, they usually need repairing because there is a risk of intestines contained within them becoming strangulated (see below).
Who develops a hernia?
Hernias are very common. Men, women and children experience hernias. Men are ten times more likely to have them than women, because of a residual weakness along the path (inguinal canal) where the testicles descended into the scrotum prior to birth. They occur in two ways: First, by wear and tear over time. Second, from a weakness in the abdominal wall that is present at birth as in children and young adults. The development of a hernia is promoted by stressing the abdominal wall, as in heavy lifting, straining in the toilet or coughing.
What are the symptoms of hernia?
Typically, an ache or discomfort is noticed when the hernia first appears, followed by the appearance of a swelling which can be less apparent first thing in the morning but becomes more obvious during the day or when you strain. The pain can be sharp and immediate, while other times it can be dull ache. Some times you might feel a vague sensation of fullness, nausea or constipation.
What are recurrent hernias?
Three patients in 100, even after treatment return back with recurrent hernia. This doesn’t necessarily indicate your surgeon’s ability, but a poor tissue healing or trauma to the site of the repair.
Once a hernia has developed, it tends to enlarge and cause discomfort. As mentioned above, if a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off leading to strangulation. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore advise that hernias be repaired when diagnosed, unless there is serious medical problem, which makes it too risky.
What is an abdominal wall hernia?
Abdominal wall hernia is a weakness or defect in the abdominal muscle wall through which abdominal contents protrude causing a bulge. The protruding contents push out a pouch of the abdominal lining or peritoneum through the weakness forming the “sac of the hernia”. The areas in which hernias most commonly develop in addition to the groin are the umbilicus and at the site of previous abdominal incision. Usually, there is an opening in the muscle layer at the umbilicus that may have been present since birth. This can enlarge due to raised abdominal pressure, with muscular strain or pregnancy and force through it, abdominal contents resulting in the development of an Umbilical hernia.
Other causes include incisions from old operations which may weaken the abdominal wall, if they do not heal properly after surgery or are weakened by infection. Muscle wall deterioration with age, inactivity or strain which may allow the muscle wall to tear or bulge, resulting in the development of various forms of hernias.
Why should it be repaired?
To avoid the possibility of intestines being caught in the hernial sac causing bowel obstruction. Without urgent surgical intervention this may lead onto strangulation, cutting off the blood supply to the bowel, with resultant death of the loop of bowel.This in turn causes peritonitis. This is a life threatening situation.- To reduce pain or discomfort at the hernia site.
- To minimize the possibility of progressive enlargement of the size of the hernia with increasing likelihood of the above complications and increasing difficult with repair.
- To alleviate any anxiety and embarrassment caused by the size of the hernia which can be visible.
