Abdominal Hernia, Incisional Hernia
A hernia is a protrusion of tissue or organ through membrane (usually muscle) that surrounds and holds the tissue or organ. The most common type of hernia is when a small piece of intestine protrudes through a hole in the abdominal muscle creating a lump, bulge or hernial sac of intestinal tissue.
This could lead to obstructed intestine (Ileus), and if the intestine ruptures, eventually resulting in life threatening peritonitis. Hernia is one of the most common conditions leading to corrective surgery. Surgery is also the only medical treatment for hernias. Hernias can be congenital or acquired. A congenital hernia is due to an inborn defect or incomplete closure of the abdominal wall, while acquired hernias are due to weakness and failure of the connective tissue in the membrane surrounding and holding an organ.
Acquired hernias are caused by strong pressure in the affected region, especially the abdomen. This could be due to chronic coughing, pressing too strongly during bowel movements, or improper technique while lifting heavy loads straining the abdominal muscles.
Complications include trapping part of the intestine (strangulated intestine) reducing or entirely cutting off blood supply causing intestinal cells to die. This potential fatal condition can only be treated by manually reinserting (termed “reducing”) the herniated tissue or organ during surgery. In extreme cases, part of the trapped tissue or organ must be removed. This is an incarcerated hernia, when part of the trapped tissue or organ has died and no longer functions. The progression of hernia is unpredictable and independent of the size of the trapped tissue or organ. Small hernias tend to be more dangerous than larger ones.
Operation is the only promising measure
Usually 1-2 days
Ability to work
after 7-10 days
There are a large number of different hernias. Among the most common are:
- Umbilical Hernia: This hernia occurs directly at or near the navel. They are most common in women suffering obesity but also may occur in pregnant women, especially after several pregnancies has weakened the abdominal wall at or near where the umbilical cord passes into the body.
- Epigastric Hernias: This type of hernia occurs in the upper abdomen between the sternum and the navel. Epigastric hernias are usually congenital, caused by a inborn defect in the abdominal tendon connecting the abdominal muscles (linea alba) thus the hernia tends to occur anywhere on a direct line between the navel and breastbone. Epigastric hernias may also be acquired due to excessive stress placed on the tendon and muscles of the upper abdomen.
- Incisional hernia: This type of hernia is caused by scar tissue after a previous abdominal operation. Any surgical procedure leaves a scar where muscle tissue has been sutured together. If the muscle tissue at the scar becomes weak, this is a defect that can open up allowing intestines or other organic tissue to press through the hole.
- Inguinal Hernia: This type of hernia is more common than any other hernia and is addressed on a separate page. See Inguinal hernia.
The first sign of a hernia is swelling or a fleshy lump on the abdomen usually but not always accompanied by pain. Coughing or pressing the muscles extends the lump outward.
Non-surgical attempts to cure hernia are nearly always futile. Using a corset, truss, belt or other external devise can actually increase the damage of a hernia. The only certain method of treating hernia is surgery.
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Surgical therapy is the only method of curing a hernia. This is especially true for strangulated hernia or obstructed hernia. The sack-like tissue or organ must be manually reinserted (reduced) into the abdomen, the hole repaired and the muscle or membrane reinforced with a prosthetic mesh. In some cases a relapse may occur if there is congenital weakness of the connective tissue, in which case the same surgical procedure must be repeated. There are several surgical procedures used to treat hernia. They all require general or local anesthesia.
Minimal Invasive surgical Methods: Laparoscopic hernia repair
We routinely use laparoscopic hernia repair during a laparoscopy. The main advantage of this method is that it is also a diagnostic procedure for determining the extent and severity of the hernia without conventional open surgery. The operation requires 3 small (3-10 mm) incisions in the abdomen regardless of whether it is a relapse, a single or double sided hernia, and occurs under full anesthetic. A Laparoscopic hernia repair is a procedure using the laparoscope, inserted into the abdomen through a small incision near the navel. The entire procedure can be thus seen on a monitor. In addition, 2 small incisions each approximately 5 mm long are made near the navel to insert other surgical instruments. The abdominal cavity is expanded with CO2 gas to improve sight and create more operating room. The light and video camera on the tip of the laparoscope display everything on a monitor in the operating room.
The herniated tissue or organ is pulled back into the abdominal cavity and the instruments are used to repair the defect in the abdominal wall. A special mesh prosthesis approximately 12×15 cm is inserted through one of the incisions and fixed to the abdominal muscle with 3-4 special titanium staples. This avoids sutures that can cause stress and tension on the abdominal muscles creating weak spots where further hernias may occur. This tension-free repair method closes the defect and promotes healing of the defect through its special mesh structure. The mesh becomes part of the muscular tissue reinforcing the region to prevent further herniation. This minimal invasive laparoscopic hernia repair requires a high degree of training and experience to ensure that it is safely, properly conducted without risk, complications and with little pain.
Conventional Invasive (open) Surgery: Hernia repair: Open surgery without prosthetic mesh
The patient is placed under general or local anesthesia and a 5-7cm long incision is made in the abdomen. The herniated sack is exposed and the defect in the muscular tissue is uncovered. The herniated sack is reduced (reinserted) into the abdominal cavity. Occasionally some of the herniated tissue must be resected (removed). Under certain conditions (such as incarcerated hernias) it will be necessary to make a further incision into the abdominal muscle in order to resect the intestine and suture the intestine together again. The incision is then sutured, and the entire muscular wall sutured. If the defect is small and does suffer any tension, then it may only require a simple suture. In other cases, it is necessary to overlap the muscle tissue creating a larger repair area and larger scar. This reinforces the muscle wall through natural muscle fibers and scar tissue that develops from the sutures, and prevents reoccurrence of hernia. No foreign prosthesis is used in this technique.
Conventional Invasive (open) Surgery: Hernia repair: Open surgery using prosthetic mesh (Lichtenstein repair or tension-free repair)
The patient is placed under general or local anesthesia and a 5-7cm long incision is made in the groin. The herniated sack is exposed and the defect in the muscular tissue uncovered. The herniated sack is reduced (reinserted) into the abdominal cavity. Occasionally some of the herniated tissue must be resected (removed). Under certain conditions (such as incarcerated hernias) it will be necessary to make a further incision into the abdominal muscle in order to resect part of the intestine and suture the intestine together again. The incision is then sutured, and the entire muscular wall sutured using the technique known as the Lichtenstein repair. The Lichtenstein repair technique is a patched tension-free repair method: the defect is sutured and a prosthetic mesh is fixed onto the muscle wall over the defective area to reinforce the muscle. This tension-free repair method closes the defect and promotes healing of the defect through its special mesh structure. The mesh becomes part of the muscular tissue reinforcing the region to prevent further herniation.
Hernia surgeries are one of the most common surgeries performed. A second operation is more difficult than the first and results in more complications due to previous scarring. The patient can begin using the groin muscle 7-10 days after the laparoscopic method or 8-12 weeks after one of the open surgery methods. Patients are usually released from the hospital after 1-2 days and are usually able to work again within 7-10 days.
The area where the hernia occurred is prone to a second hernia, if care is not taken. Patients are advised to wear an abdominal band for 3 weeks after surgery. A reoccurrence is possible if the abdominal muscles are strained too much through heavy coughing, heavy lifting or overactive athletic activities. Obesity can also lead to a reoccurrence of hernia. Hernia relapse is most common within 2 years after a successful hernia operation.
Notice: Preoperative preparation: Please inform your physician if you are taking blood thinning medication such as Aspirin® and Marcumar® as they may lead to complications during surgery.
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