Internal organs are enclosed within the abdominal wall which is made up of layers of muscle, fat and tissue. Weakness in any part of the abdominal wall causes the internal organs to bulge out of their normal position. This bulge is called a hernia.
Hernias may develop before birth (congenital hernia) when the lining of the organs do not close completely to encompass the internal organs. Increased abdominal pressure or weakness around an area of incision made during a surgery can also result in hernia.
Hernias are classified based on their location. The different types of hernia include:
- Inguinal hernia (inner groin): This is the most common type of hernia in men and occurs in the lower abdominal area where the abdomen and legs meet (groin).
- Incisional hernia: This type of hernia occurs when the abdominal wall is pushed out at a site weakened by a previously made incision of an abdominal surgery.
- Femoral hernia (outer groin): It appears on the upper region of the thigh when the intestine bulges out into the passage of the femoral artery (large blood vessel supplying blood to the lower extremity).
- Umbilical hernia (belly button or navel): This hernia is common in newborns, women who are obese or in those who have had many children. Part of the small intestine or fat bulges out from the navel.
- Hiatal hernia (upper stomach): This occurs when the upper part of the stomach is pushed up through the diaphragm (muscle separating the chest from the abdomen).
Most hernias show no symptoms except for a small lump that can be pushed back inside, but may appear again when strain (like coughing) is applied. They may be painless, but some may feel an ache or discomfort, which may intensify with activities like lifting or bending. The bulging hernia itself does not cause pain, but the internal organs pressing against the abdominal wall can result in discomfort.
Over time, the lump may grow, become sore, and even get strangulated (trapped), a condition where the blood supply is blocked to the area requiring immediate medical attention. Entrapment of a hernia may lead to swelling, skin discolouration (blue or red), vomiting, pain, urination problems and bowel obstruction. A strangulated hernia may further lead to complications that may include, but are not limited to gangrene (death of tissue) or peritonitis (inflammation of the abdominal inner wall). Strangulated inguinal hernias may cause vomiting and fever in children.
Your doctor will collect your medical history and conduct a physical exam. A thorough examination for swollen bulged areas on the abdomen, groin, scrotum, or thigh will be performed. Your doctor may be able to see or feel the bulge when you cough, stand up or strain your abdominal wall and see or feel it reduce in size when you lie down.
If required, your doctor may order special tests such as a herniagram or an ultrasound for diagnosis.
Surgical repair is the only option for treating hernia. Your doctor may choose to avoid surgery for a while if the hernia does not cause any pain or discomfort. However, if left untreated for a long time, it may have a risk of enlarging and becoming strangulated (trapped), which may require emergency surgical repair, or may increase the complications of late surgery. Your surgeon may follow different approaches to repair your hernia. The two basic steps for any surgical hernia repair include:
- Pushing back the bulge to its original position inside the abdominal cavity
- Closing the opening from where the hernia had protruded
Your surgeon will perform either an open or a laparoscopic surgery based on which procedure is suitable for your condition.
Open Hernia Repair: This procedure is performed under local or general anaesthesia. Your surgeon will make an incision on the abdomen and manually push the bulge back into place. This is followed by repair of the hernia as described below.
Laparoscopic Hernia Repair: Laparoscopy will be performed under general anaesthesia. Your surgeon will make several small incisions on the abdominal wall and insert a laparoscope (instrument with a lighted device and a camera) through one of the incisions and surgical instruments through the others. Carbon dioxide gas will be inflated into your abdominal cavity which will make it easier for the surgeon to view the organs and perform the procedure.
Your surgeon will then perform either hernioplasty or herniorrhaphy depending on the damage.
- Hernioplasty: This technique is preferred in cases of complete damage and rupture of the abdominal wall. After the internal organs are put back in place, your surgeon will stitch a sterile synthetic mesh over the weak area and to the abdominal wall, for support.
- Herniorrhaphy: This technique is preferred when the intestinal contents leak due to a torn abdominal wall. Your surgeon will stitch the edges of healthy tissue of the abdominal wall together after putting the bulge back in its place.
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