Romane Joseph, MD
A protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it.
You can easily see and feel the bulge most often when you are upright; however not all hernias are visible by the patient, especially when obese.
Symptoms commonly include pain at hernia site when doing daily activities such as bending, lifting heavy objects, or even coughing. Symptoms do not improve on its own and without medical attention can lead to life-threatening complications.
Your doctor will likely recommend surgery to repair a painful or enlarging hernia.
It is estimated that more than 20 million hernias are repaired yearly around the world. Approximately 700,000 hernia repairs are carried out yearly in the USA.
CAUSES OF HERNIA
Some hernias have no apparent cause. Others might occur as
a result of:
• Increased pressure within the abdomen
• A pre-existing weakened spot in the abdominal wall
• Straining during bowel movements or urination
• Strenuous activity
• Chronic cough or sneezing
Factors that contribute to developing a hernia:
• GENDER – Men are eight times more likely to develop an inguinal hernia than women. Umbilical/Ventral hernias are more common in females.
• ADVANCED AGE – Muscles weaken as you age.
• FAMILY HISTORY – Having a close relative, such as a parent or sibling, with a history of hernia.
• CHRONIC COUGH – Such as from smoking.
• CHRONIC COUGH – Smoking places you at higher risk for hernia development.
• PREGNANCY – Being pregnant can weaken the abdominal muscles causing increased pressure inside
• PREVIOUS HERNIA OR HERNIA REPAIR – Even if your previous hernia occurred in childhood, you are at higher risk of developing another hernia.
SIGNS OF TROUBLE
Hernias can become strangulated or “incarcerated” meaning that blood flow to the tissue is cut off and becomes trapped. This is a life-threatening complication if not treated.
Strangulated hernia signs and symptoms:
• Nausea, vomiting or both
• Sudden pain that quickly intensifies
• Hernia bulge that turns red, purple or dark in color
• Inability to move your bowels or pass gas
VARIOUS TYPES OF HERNIAS
Ventral hernias occur in anterior midline locations of the abdomen. These are known as Primary Ventral Hernias and include areas such as: Epigastric, Umbilical and Spigelian). Ventral Parastomal hernias are a
type of ventral hernia resulting after stoma surgery. Another type is the ventral incisional hernia post-surgical procedure.
The groin is the region at the lower margin of the abdomen where the thigh meets the hip. Groin hernias are subclassified into inguinal and femoral hernias.
Pelvic hernias protrude through one of the pelvic foramina (sciatic and obturator hernia) or the pelvic floor (perineal hernias).
FLANK/ LUMBAR HERNIA
Flank hernias protrude through weakened areas of back musculature and include the superior and inferior lumbar triangle hernias.
The most common groin hernia is the inguinal hernia. Inguinal hernia complications produce increased healthcare resource consumption due to high lifetime risk factors; 27% for men and 3% for women. It is estimated that inguinal hernias occur 20 times more often in men than women.
A condition in which the upper part of your stomach bulges through an opening in your diaphragm. Your diaphragm is the thin muscle that separates your chest from your abdomen. Your diaphragm helps keep acid from coming up into your esophagus such as in GERD or Acid reflux. Most people with a hiatal hernia experience any signs or symptoms and rarely require treatment. However, if you experience bothersome symptoms such as recurrent heartburn or acid reflux you may require treatment which may include medications or surgery.
Common symptoms of Hiatal Hernia:
• Heartburn that worsens when leaning over or lying down
• Chest pain or epigastric pain
• Trouble swallowing and/or frequent belching
Femoral hernia is the 3rd most common type of primary hernia. In fact, femoral hernias account for nearly 14% of hernias in women and 2% in men worldwide.
The definitive treatment of most hernias, regardless of their origin or type, is surgical repair. Many techniques have been used, and these can be categorized as tension free repairs that typically use mesh and primary tissue approximation repairs that do not use mesh.
The most commonly used open approaches include the Lichtenstein repair; the plug and patch repair; and the open, preperitoneal approach. When performed by experienced surgeons, each of these is associated with low recurrence rates.
In general, the open approach remains preferred over a Laparoscopic/ Robotic approach for primary, unilateral inguinal hernia repair in men. Even so, the approach should be individualized on the basis of patient variables and surgeon skill set.
LAPAROSCOPIC/ ROBOTIC HERNIA REPAIR
Minimally invasive surgical approaches offer the potential for reduced postoperative pain and a quicker return to normal activities.
When performing laparoscopic/ robotic inguinal or femoral hernia repair, the hernia defect is approached from its posterior aspect and the repair involves placing mesh in the preperitoneal space.
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