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Hernia

A hernia is the protrusion of organs through a weakness or defect in the abdominal muscle wall. The protruding contents push out a pouch of the abdominal lining through the weakness forming the "sac of the hernia".

The abdominal wall isn't a solid sheet of muscle; it is made up of different layers. Certain areas are structurally weaker than others and therefore more likely to develop hernias.

The different types of hernia include:

  • Inguinal: occurring in the groin. A loop of intestine pushes against the small ring of muscle in the groin, eventually splitting the muscle fibres apart. Inguinal hernias affect more men than women and are particularly common in middle age.
  • Femoral: occurring high on the thigh, where the leg joins the body. Similar to an inguinal hernia, intestines force their way through the weak muscle ring at the femoral canal until they protrude. This herniated section of bowel is at risk of strangulation, which is a serious complication requiring urgent medical attention. Femoral hernias are more common in women.
  • Umbilical: a portion of the stomach pushes through a muscular weakness near the belly button. This type of hernia is more common in newborns. Overweight women or those who have had several pregnancies, are also at increased risk.
  • Incisional: after abdominal surgery, the site of repair will always be structurally weaker. Occasionally the intestines can push through the closed incision, causing a hernia.

Symptoms


The symptoms of a hernia can vary depending on the location and severity, but may include:

  • A visible lump or a swollen area
  • Pain or aching, particularly on exertion (such as lifting or carrying heavy objects)
  • Digestive upsets, such as constipation
  • A heavy or uncomfortable feeling in the stomach, particularly when bending over
  • The lump disappears when lying down
  • The lump enlarges upon coughing, straining or standing up.

Strangulated hernia

If the hernia resists manual pressure and can't be popped back through the abdominal wall, it is known as a non-reducible hernia. This means that the intestinal loop is held tight by the muscular ring, which can lead to further swelling of the loop and eventual strangulation of the entrapped bowel. The femoral hernia is the most susceptible to this complication.

Symptoms of a strangulated hernia include nausea, vomiting and severe pain. Prompt medical attention and surgery is vital. Untreated, a strangulated hernia can lead to gangrene of the trapped bowel.

Surgical Procedures to Repair Hernias 

Open Surgery

An incision is made at the site of the hernia. The protruding tissue and organs are pushed back into the abdominal cavity and the muscles are stitched together. A thin plastic mesh may or may not be used to place under or over the muscles to add support.

Laparoscopic Surgery (key-hole surgery)

A laparoscope (a thin telescope connected to a video camera) is inserted though small incisions in the abdominal wall and allows your surgeon to view the hernia via a video monitor. Carbon dioxide gas is blown into the abdomen to lift the abdominal wall. Once the surgeon clears away the tissue surrounding the hernia, the "sac" is removed. The hole in the abdominal wall is then covered with surgical mesh .