What is a Hernia?
A hernia is a weakness or opening in the abdominal wall, which often results in soft tissue such as fat or intestine protruding through the abdominal muscles and occupying space under the skin. The mechanism of the hernia is similar to what happens with a bulge in a damaged tire, where the inner tube, normally contained by the hard rubber of the tire, extends through a thin or weakened place. The opening in the abdominal wall that leads to the hernia is also known as a hernia defect.
Inguinal and Ventral Hernias
Inguinal hernias are the most common of all hernias, and are sometimes referred to as groin hernias. They occur near the crease between the lower abdomen and the upper thigh. When an inguinal hernia develops, intestine may protrude through the defect in the abdominal wall, creating a bulge on the right or left side. Inguinal hernia bulges are frequently, though not always, painful. Between 10 and 15 percent of males and two percent of females will develop inguinal hernias in their lifetime.
Ventral hernias are less common than inguinal hernias, with some 10 percent of both males and females expected to develop one during their lifetime. These hernias occur outside the inguinal area of the abdomen, in the epigastrium, the part of the abdominal wall above the umbilicus (belly button) and/or within the umbilicus itself. The Spigelian hernia, another more rare type of ventral hernia, occurs in the mid-abdomen.
Inguinal and ventral hernias may develop due to a number of factors, including obesity, aging, and strenuous physical activity requiring heavy lifting, such as construction work. Certain rare conditions such as collagen vascular disease or genetic defects involving connective tissue may also cause abdominal hernias.
Incisional hernias occur where prior abdominal surgery has weakened the abdominal wall, or where infection in a healing surgical incision causes breakdown of the wound closure. Incisional hernias are common in patients who have had intestinal surgery complicated by wound infections. About 25 to 30 percent of both males and females will develop an incisional hernia when a wound infection occurs after abdominal surgery.
Hiatial hernias take place in the diaphragm, the large muscle separating the chest cavity and the abdomen. The diaphragm is responsible for much of our breathing. Surgeons in Columbia's Division of General Surgery repair hiatal hernias.
Hernias are most often diagnosed during a routine physical exam. Accurate diagnosis sometimes requires a CT (CAT) scan.
Surgical Hernia Repair
Anyone who has the symptoms of a hernia, such as pain or a bulge, should consider having a hernia repair. All candidates for hernia repair are evaluated to identify factors that can be modified to minimize the risk of complications.
Hernia repair is conducted using one of two surgical approaches, both of which utilize a piece of synthetic, or prosthetic, mesh to reinforce the weakness in the abdominal wall. When expertly performed, both approaches result in a successful hernia repair.
Open Surgical Repair
The surgeon makes an incision directly over the hernia defect and sews the prosthetic mesh to the abdominal wall. The surgery is done on an outpatient basis, usually under local anesthesia with conscious sedation. This approach is very successful in the repair of small hernias.
Alternatively, a hernia may be repaired using a minimally invasive, or laparoscopic, approach performed while the patient is under general anesthesia. The surgeon inserts small tubes called cannulas through the abdominal wall at some distance from the hernia defect. A mesh prosthesis is then passed through one of the tubes into the abdomen and fixed to the undersurface of the abdominal wall with stitches and staples. This technique is used for both small and large hernias of the abdomen.