Hernia

Definition

A hernia is an abnormal protrusion of part of an organ through the tissues that normally contain it. In this condition, a weak spot or opening in a body wall, often due to laxity of the muscles, allows part of the organ to protrude.

A hernia may develop in almost any part of the body; however, the muscles of the abdominal wall are most commonly affected.

Description

Hernias cause pain and reduce general mobility. They never cure themselves, even though some can be cured (at least temporarily) by external manual manipulation. Depending on the nature of the protruding organ and the solidity of the structure through which it is protruding, a hernia may cause complications that are medically dangerous.

One major danger of a hernia is that if bowel is contained within the protruding loop it may hinder or stop the flow through the intestine (occlusion). More serious still, if the loop itself becomes twisted outside its containing structure, or compressed at the point where it breaks through that structure (a strangulated hernia), the blood supply to the loop will also cease and the entire hernia will undergo tissue death (necrosis). This requires immediate emergency surgery.

Types Of Hernia

Although there are many types of hernias, the following are the most common:

Abdominal wall hernia: Also called an epigastric or ventral hernia; affects 1 person in 100 nationwide. Technically, this group also includes inguinal hernias and umbilical hernias.

Indirect inguinal hernia: This affects men only. A loop of intestine passes down the canal from where a testis descends early in childhood into the scrotum. If neglected, this type of hernia tends to increase progressively in size (a "sliding hernia") causing the scrotum to expand grossly.

Direct inguinal hernia: This affects both sexes. The intestinal loop forms a swelling in the inner part of the fold of the groin.

Femoral hernia: This affects both sexes. An intestinal loop passes down the canal containing the major blood vessels to and from the leg, between the abdomen and the thigh, causing a bulge in the groin and another at the top of the inner thigh.

Umbilical hernia: This affects both sexes. An intestinal loop protrudes through a weakness in the abdominal wall at the navel (but remains beneath the skin).

Hiatal hernia: This affects both sexes. A loop of the stomach when particularly full protrudes upward through the small opening in the diaphragm through which the esophagus passes, thus leaving the abdominal cavity and entering the chest.

Incisional hernia: This is a hernia that occurs at the site of a surgical incision. This is due to strain on the healing tissues due to excessive muscular effort, lifting, coughing, or extreme pressure.

Symptoms

Symptoms of hernias vary, depending on the cause and the structures involved. Most begin as small, hardly noticeable break-throughs. At first, they may be soft lumps under the skin, a little larger than a marble; there usually is no pain. Gradually, the pressure of the internal contents against the weak wall increases, and the size of the lump increases.

Early on, the hernia may be reducible - the protruding structures can be pushed back gently into their normal places. If those structures, however, cannot be returned to their normal locations through manipulation, the hernia is said to be irreducible, or incarcerated.

Treatment

For small, nonstrangulated hernias and nonincarcerated hernias, various supports and trusses may offer temporary, symptomatic relief. However, the best treatment is herniorrhaphy (surgical closure or repair of the muscle wall through which the hernia protrudes).

When the weakened area is very large, some strong synthetic material may be sewn over the defect to reinforce the weak area. Postoperative care involves protecting the patient from respiratory infections that might cause coughing or sneezing, which would strain the suture line. Recovery is usually quick and complete.

Questions to Ask Your Doctor

What type of hernia is it and is surgery recommend?

How new is this surgery? Is this the accepted treatment for this diagnosis?

What kind of anesthetic will be used? Are there alternatives?

What are the risks or complications to this surgery?

What is the success rate and will the surgery take care of the problem completely?

What are the likely consequences and alternatives if surgery is delayed or declined?

Are there alternatives to the proposed surgery and what are the risks and benefits of each?

What precautions should be taken after the surgery?