Our surgeons are adept at repairing complex inguinal, umbilical, and ventral hernias, including primary and recurrent hernias and hernia previously considered irreparable. We use the newest bioprosthetic materials and laparoscopic techniques to prevent recurrence, minimize pain, and facilitate a more rapid return to normal activity.
What is a Hernia?
A hernia is a weakness that generally occurs in the wall of the abdomen, permitting an organ, a part of an organ, or fat to protrude. Hernia is among the most common medical disorders. Hernias may occur at any age, and they can be congenital (present at birth) or acquired (see Hernia Risk Factors). A common location for hernia is in the groin, and men tend to develop groin (or inguinal) hernias more often than women. The primary symptom is pain, which may get worse with long periods of standing or lifting heavy objects, and is often accompanied by a bulge in the abdomen or groin. Although inguinal hernias are the most common, hernias may also occur in the navel (umbilical), above the navel (epigastric), and at the site of previous surgery (incisional).
Complications of Hernias
Hernias do not get better without treatment, although some people find relief from over-the-counter pain remedies. A supportive garment called a 'truss' may provide some relief for inguinal hernias. If left untreated, some hernias may become "incarcerated," meaning that the protruding structure (particularly intestine) gets trapped in the hole that makes up the hernia. This can lead to two dangerous conditions: obstruction or strangulation. When intestine becomes obstructed, digested food cannot pass, leading to vomiting, an inability to pass feces or gas, and ultimately severe dehydration and potential damage to the intestine if not treated within hours. Strangulation occurs when a section of the intestine cannot obtain adequate blood flow. This potentially life-threatening condition causes symptoms such as blood in the stool, severe abdominal pain, vomiting, fever, and even shock. It also requires emergency treatment.
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.
Hernia Risk Factors
You may be at risk for developing a hernia if you experience one or more of the following:
- A chronic cough, such as a smoker's cough
- Chronic straining during bowel movements or while urinating
- Straining to lift heavy objects
- Persistent sneezing, such as might be caused by allergies
- Previous wound/surgery in the area
These factors can either cause or exacerbate a weakness of the abdominal wall, allowing an organ or fatty tissue to push through.
Treatment for Hernias
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.
Hernias may be repaired using conventional open techniques or via a laparoscopic approach, in which a long, thin camera and instruments are introduced via small incisions. Most hernia repairs require the use of synthetic, or prosthetic, surgical mesh used to reinforce the weakness in the abdominal wall. When expertly performed, both approaches result in a successful hernia repair.
Although laparoscopic surgery usually requires general anesthesia, open hernia repairs can frequently be performed with local or regional anesthesia. In some settings, patients experience a shorter recovery time and less post-operative discomfort with laparoscopic than with open surgery. However, the decision about the optimal approach for repair of a particular hernia is an individual one.