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Hernia Hernias How do hernias develop? Types of hernias Where do hernias develop? Hernia Surgery Risks & Complications Recovering from Surgery When to call the doctor? What is a hernia? A hernia is a weakness or defect in the abdominal wall. It may be present from birth or develop over a period of time. If the defect is large enough, abdominal contents, such as bowels, may protrude through the defect causing a lump or bulge that can be felt. Hernias develop at certain sites, which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions. A hernia is like an inner tube bulging out of a hole in an old tire. One part of the body slips through the outer wall, the abdomen, into another part of the body. What is a hernia?
A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents, such as bowels, may protrude through the defect causing a lump or bulge that can be felt. Hernias develop at certain sites, which have a natural tendency to be weak: the groin, umbilicus (belly button), and previous surgical incisions.
A hernia is like an inner tube bulging out of a hole in an old tire. One part of the body slips through the outer wall, the abdomen, into another part of the body.
How do hernias develop? The wall weakens or tears. The abdominal wall sometimes weakens and sometimes tears. When this happens, a loop of intestines or fat usually pushes up against the lining of the abdominal wall, forming a sac. The intestines push into the sac. Most hernias form a bulge into the sac. Although not an immediate emergency, they do need to be repaired. The hernia may be a reducible hernia if it flattens out when you lay down or returns to the inside of the abdomen when you push on it. How do hernias develop?
The wall weakens or tears. The abdominal wall sometimes weakens and sometimes tears. When this happens, a loop of intestines or fat usually pushes up against the lining of the abdominal wall, forming a sac.
The intestines push into the sac. Most hernias form a bulge into the sac. Although not an immediate emergency, they do need to be repaired. The hernia maybe a reducible hernia if it flattens out when you lay down or returns to the inside of the abdomen when you push on it. [back to the top]
Types of Hernias Incarcerated Hernia The hernia is incarcerated if the intestines become trapped in the opening and can't be pushed back into the abdomen when you push on it. It is very painful and requires surgery. Strangulated Hernia The hernia is strangulated if it becomes tightly trapped in the opening. The intestines eventually die due to lack of blood supply. This requires surgery, as it causes the intestines to become obstructed. Types of Hernias Incarcerated Hernia
The hernia is incarcerated if the intestines become trapped in the opening and can't be pushed back into the abdomen when you push on it. It is very painful and requires surgery. Strangulated Hernia
The hernia is strangulated if it becomes tightly trapped in the opening. The intestines eventually die due to lack of blood supply. This requires immediate surgery, as it becomes the intestines to become obstructed. [back to the top]
Where do hernias occur? Indirect Inguinal Hernia
- located in the groin, a result of a weakness in the inguinal ring
- the most common type of hernia
- can be present at birth
- may occur later in life
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| Intestine drops into the internal ring |
Direct Inguinal Hernia
- occurs in the inguinal area, near the inguinal ring
- occur less frequently than indirect inguinal hernia
- are more common in men
- usually occur after the age of 40
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| intestine pushes through weak muscle |
Incisional Hernia
- occurs at the site of a previous surgical incision, usually in the abdomen
- may develop months after surgery or may take years to develop
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| intestine pushes through scar tissue |
Umbilical Hernia
- occurs in the inguinal area, the belly button
- it is usually caused by a weakness that may be present from birth or may develop over time
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| intestine pushes through the umbilical ring |
Femoral Hernia
- more common in women
- occur as a result of a weakness in the femoral area, below the groin
- can cause serious complications, such as strangulation
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| hernia sac drops into femoral canal |
Hernias in Children
- hernias in children are present at birth
- the most common type are umbilical and indirect inguinal hernias
- umbilical hernias may not require surgery
- indirect inguinal hernias usually require surgery
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| umbilical hernia incision |
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| indirect inguinal hernia incision |
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Hernia Surgery How are hernias repaired? Open hernia repair
- This is the standard repair and involves an incision in the abdominal wall.
- Normal healthy tissue is cut until the area of weakness is found.
- The hernia is then repaired with sutures.
- Many times a prosthetic device, such as mesh, is sutured in place to strengthen the area of weakness.
Laparoscopic hernia repair
- The defect in the abdominal wall is repaired from the inside of the abdominal cavity.
- Instead of closing or patching the repair from the outside, the patch is secured in place from the inside.
- This eliminates cutting the skin and normal tissue to get down to and repair the hernia.
- This is done using a laparoscope, or a surgical telescope, that is inserted through a small puncture site in the abdominal wall.
- Under video guidance and a camera, the hernia is identified and repaired.
[back to the top] What are the advantatges and disadvantages of the 2 types of hernia repairs? Advantages - Open Hernia Repair
- can be done under local anesthesia which is safer than general anesthesia
- has been done for many years
- is considered to be safe and effective
- usually, an outpatient procedure
Disavantages - Open Hernia Repair
- larger incision with a bigger scar
Advantages - Laparoscopic Hernia Repair
- because the incisions are so small, recovery is quick
- most people have minimal pain
- most people return to normal activity in less than a week
- both sides can be fixed at the same time
- repair of choice for recurrent hernias
- allows access to the abdominal cavity where other problems may be diagnosed and treated at the same time
- usually an outpatient procedure
Disadvantages - Laparoscopic Hernia Repair
- requires general anesthesia, which increases the risk in the elderly patient
- risk of puncturing the bowel or a blood vessel
- formation of adhesions or scar tissue in the abdominal cavity
- may be more difficult in people who have had previous abdominal surgery
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Risks and Complications Open Hernia Repair
- bleeding, possibly requiring re-operation
- infection, possibly requiring re-operation to remove mesh if it was used
- nerve injury resulting in numbness or chronic pain in the groin area
- urinary retention
- excessive bruising
- testicular or groin swelling
- recurrent hernias
- deterioration of the testes
- deep vein thrombosis
- injury to or loss of testicle(s) or spermatic(s), possibly causing sterility
Laparoscopic Hernia Repair
- bleeding, possibly requiring re-operation
- infection, possibly requiring re-operation to remove mesh if it was used
- pain and numbness in the groin, sometimes requiring open surgery
- bowel injury
- urinary retention
- excessive bruising
- testicular or groin swelling
- recurrent hernia
- deterioration of the testes
- deep vein thrombosis
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Recovering from Hernia Surgery Open Hernia Repair
- LIFTING--lift only light objects that can be easily managed for 4-6 weeks
- SEX--you may resume sexual relations as soon as you feel comfortable
- DRIVING-- you may drive 1-2 weeks after your surgery if you feel comfortable. Don't drive while taking pain medication
- EXCERCISE-- moderate exercise is okay
- WORK--
- If you have a desk job, you may be able to return to work in a couple of weeks
- If your job requires more physical activity, it may be 4-6 weeks before you may return to work
Laparoscopic Hernia Repair
- LIFTING-- lift only light objects that can be easily managed for 4-6 weeks
- SEX-- you may resume sexual relations as soon as you feel comfortable
- DRIVING -- avoid driving for 1-2 days after surgery if you feel comfortable. Don't drive while taking pain medication.
- EXCERCISE-- moderate exercise is okay
- WORK:
- Laparoscopic surgery allows you to return to work quicker
- If you have an office job, you may return to work in a few days.
- For more physical jobs, it may be 2 weeks before you may return to work.
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When to call the doctor?
If you experience any of the following problems:
- fever > 101 degrees
- excessive swelling (some testicular swelling is normal following hernia repair)
- redness (Discoloration and brusing, black and blude, green and yellow is a product of the surgery resulting from blood in the tissue. DO NOT BE ALARMED, THIS IS A NORMAL OCCURRENCE.)
- bleeding
- urinary retention following open hernia repair
- increasing abdominal pain following laparoscopic repair
- nausea and vomiting following laparoscopic repair
- pain in the calf and/or swelling of the legs
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