Hernias

A hernia is a weakness in the abdominal wall leading to protrusion of an organ, such as the bowel, through the wall. There are many different types of hernias. Most commonly they involve the abdomen especially the groin.
Groin hernias can be inguinal or femoral hernias, other common hernias include incisional, umbilical and epigastric hernias. Symptoms include pain or discomfort especially with coughing, exercise, or going to the toilet. It can get worse throughout the day and improve with lying down. A bulging area may occur that becomes larger when bearing down. Complications include strangulation, where the blood supply to part of the bowel is blocked or obstruction in which bowel content cannot pass through due to blockage. These can cause severe pain and tenderness of the area.
Hernias may have a genetic predisposition but embrological development also plays an important role. Other risk factors include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy.
Groin hernias can get larger with time and due to associated complications a repair is recommended for most patients. Hernias that do not cause symptoms especially in elderly patients may not need repairing. Immediate surgery is required for strangulation or obstruction. Repair may be done by open surgery or by laparoscopic surgery. Laparoscopic surgery is associated with reduced pain but the risk of complications is slightly higher. Mesh is used for the treatment of most hernias to reduce the risk of recurrence.
Umbilical or paraumbilical hernias are also at risk of stragulation and a repair is usually recommended.
An incisional hernia occurs when the defect is the result of an incompletely healed previous surgical wound or a protrusion due to weakness in the scar. These are usually symptomatic and may be associated with bulge, pain or bowel obstruction. They are difficult to repair due to the weakness of tissues and the size of defect. Newer techniques including use of special meshes and component seperation techniques may improve results of repair.