A hernia is a common condition in which part of an internal organ or tissue bulges through a muscle. An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the lower abdominal wall into the inguinal, or groin, area. There are 2 types of inguinal hernias:
Hernias can be on one or both sides of the abdomen.
Incarceration or strangulation of inguinal hernias is rare, but serious complications can develop if a hernia is left untreated.
Some inguinal hernias have no apparent cause. Others might occur as a result of:
In many people, the abdominal wall weakness that leads to an inguinal hernia occurs prior to birth when a weakness in the abdominal wall muscle doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.
In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place
Factors that contribute to developing an inguinal hernia include:
Inguinal hernias may be painless or cause no symptoms, especially when they first appear. Symptoms that can develop include:
Although you can’t prevent genetic risk factors, it’s possible to reduce your risk of occurrence or the severity of abdominal hernias. Follow these tips:
Early surgical treatment can help cure inguinal hernias.
Inguinal hernia repair is a common surgical procedure. Inguinal hernia surgery is also called herniorrhaphy or hernioplasty. There are 2 types of inguinal hernia repair:
Advantages of Laparoscopic Hernia Repair
An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes. All abdominal surgeries carry a 33 percent risk of a postoperative incisional hernia, and approximately 33 percent of people undergoing abdominal surgery will experience an incisional hernia.
Hernias are often categorized as reducible or irreducible:
Irreducible hernias can lead to bowel obstruction, which can then lead to a strangulated hernia. This requires immediate treatment..
Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision. An incisional hernia can occur for a number of specific reasons; individuals who participate in excessive or premature physical activity after surgery, gain considerable weight, become pregnant or increase abdominal pressure in any other way before the incision is fully healed are especially at risk for an incisional hernia. Incisional hernias are most likely to occur within three to six months post-surgery but can happen at any time.
Several risk factors can increase the chances of a hernia developing after surgery, including:
You can help lower your risk for a hernia by taking the recommended amount of time to heal after abdominal surgery.
The most noticeable symptom of an incisional hernia is a bulge near the incision site. It’s often most visible when you strain your muscles, such as when you stand up, lift something, or cough.
Besides a visible bulge, incisional hernias might also cause:
An incisional hernia develops after abdominal surgery, when an area of the intestine or other tissue pushes through the abdominal wall at or near the site of an incision.
It most commonly develops three to six months after abdominal surgery, when your abdomen is healing from the incision.
The following steps may reduce your risk of an incisional hernia after surgery:
Hernias don’t go away on their own and are only treatable with surgery.a. Small or reducible hernias
If you have a small or reducible hernia, you may be able to safely delay surgery. Your healthcare provider will consider your medical history and other factors when deciding if surgery will repair the hernia.
If your hernia causes little or no discomfort, it may be safe to watch the hernia and wait before having surgery. It’s important to note, though, that operations for larger hernias can be more difficult than operations for small hernias.b. Large or irreducible hernias
If your hernia grows or becomes irreducible, you’ll need surgery. The recommended option will generally depend on your symptoms, the size of the hernia, and your medical history.
Open hernia repair involves an incision at the hernia site. A surgeon will move tissue, intestine, and other organs forming the hernia back into the abdomen and close the opening.
They may also use mesh patches to reinforce the spot where the hernia developed. These mesh patches are sewn to the tissue around the hernia, where they’ll eventually be integrated into your abdominal wall.
Laparoscopic hernia repair involves multiple small cuts instead of one large cut. Hollow tubes are placed in these incisions, and air inflates your abdomen to make your organs more visible. A surgeon will then insert surgical tools, including a small camera, into the tubes to perform the surgery. Mesh may also be used in a laparoscopic repair.
Laparoscopic surgery is less invasive, and you may leave the hospital sooner and have a lower risk of infection, though it might not be as effective for very large or severe hernias.
An umbilical hernia is an unusual bulge that you can often see or feel over the belly button (the umbilicus). An umbilical hernia develops when part of the intestine, together with fat or fluid, forms a sac. This sac pushes through an opening in the muscle of the abdominal wall.
Too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen include:
Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. The condition affects boys and girls equally.
For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia tends to be more common in women.
For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to abdominal pain and tissue damage.
Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines. Emergency surgery is typically required to treat these complications.
Umbilical hernias can usually be seen when your baby is crying, laughing, or straining to use the bathroom. The telltale symptom is a swelling or bulge near the umbilical area. This symptom may not be present when your baby is relaxed. Most umbilical hernias are painless in children.
Adults can get umbilical hernias as well. The main symptom is the same — a swelling or bulge near the navel area. However, umbilical hernias can cause discomfort and be very painful in adults. Surgical treatment usually is required.
The only way to repair an umbilical hernia is through surgery. An umbilical hernia repair surgery helps to push the sac back into place and strengthen the abdominal wall. There are two types of surgery available to repair the hernia.
Without repair, your hernia can continue to grow and become more painful over time. The risk of the sac becoming incarcerated or strangulated goes up the longer your umbilical hernia goes untreated.
A femoral hernia is fairly uncommon and is most commonly found in women. Femoral hernias are found in the groin region and can appear as a painful lump on the inner, upper thigh. The lump can be pushed back in and can sometimes become more prominent when straining or coughing. They are more common in women because women have a wider pelvis.
The exact cause of femoral hernias are unknown most of the time. You may be born with a weakened area of the femoral canal, or the area may become weak over time.
Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:
Small and moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.
Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Femoral hernias are often located very close to the hip bone and as a result may cause hip pain.
Severe symptoms can signify that a femoral hernia is obstructing your intestines. This is a very serious condition called strangulation. Strangulation causes intestinal or bowel tissue to die, which can put your life in danger. This is considered a medical emergency. Severe symptoms of a femoral hernia include:
Hernias often get larger as time passes. They do not go away on their own. Compared to other types of hernias, femoral hernias more commonly have small intestine get stuck in the weak area. Surgery is recommended to avoid a possible medical emergency.
Femoral hernia repair can be done as either an open or laparoscopic surgery. An open procedure requires a larger incision and a longer recovery period. Laparoscopic surgery uses three to four keyhole-sized incisions that minimize loss of blood.
A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm).
Your diaphragm has a small opening (hiatus) through which your food tube (esophagus) passes before connecting to your stomach. In a hiatal hernia, the stomach pushes up through that opening and into your chest.
The exact cause of many hiatal hernias isn’t known. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm.
Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:
Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it.
Factors that can increase your risk of a hiatal hernia include:
Most small hiatal hernias cause no signs or symptoms. But larger hiatal hernias can cause:
Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.
If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.
Surgery for repairing a hiatal hernia involves:
During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.
Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.
A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:
Acid reflux causes most hiatal hernia symptoms. Changing your diet can reduce your symptoms. It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.
There are also certain foods that may increase your risk of heartburn. Consider avoiding:
Other ways to reduce your symptoms include:
The diaphragm is a muscular sheet that separates the lungs from the contents of the abdomen. The main function of this sheet is to help in respiration. Just like the plunger in a syringe, the diaphragm moves down during breathing and creates a negative suction pressure in the chest. This action sucks the air from the atmosphere into the lungs.
Due to various reasons, this muscular sheet can have a defect or a hole. Through this hole, the contents of the abdominal cavity can migrate up into the chest and lie there. This causes compression of the lungs on that side, thereby preventing its effective expansion and breathing. This condition is referred to as a diaphragmatic hernia.
A diaphragmatic hernia is an uncommon condition. Most commonly, the defect occurs because of a developmental problem when the child is in the womb of the mother. The children are born with this defect. Many times, this is diagnosed immediately after birth when the hernia is large, and the child develops breathing difficulty. Sometimes this problem can go unnoticed till adulthood when it is diagnosed by an X-ray done routinely for some other problem.
This problem can also arise due to other reasons like trauma, obesity and as a result of some surgeries.
The most common symptom is difficulty in breathing. This can occur during rest when the hernia is very big. In moderate size hernias the patient might experience breathing difficulty during exertion like running or climbing stairs. Babies born with large hernia can have severe breathing problems after birth and may be needed to be kept on artificial breathing support on a ventilator.
Sometimes when the intestines which have migrated into the chest can get twisted and this can cause intestinal obstruction causing vomiting and inability to pass stools. This is a serious life threatening emergency.
When there is a defect or hole in the diaphragm, the respiratory movement is not very effective. And through this hole the intestines can start slowly migrating up from the tummy into the chest.
As more and more intestines move into the chest cavity. The lungs in the chest does not have enough space to expand because the chest cavity gets occupied with intestines gradually.
This is the reason that the diaphragmatic hernia generally presents with respiratory complications. Patients come with breathlessness complaining about gradually increasing difficulty in breathing. And when we do a scan or X ray we find a large diaphragmatic hernia.
There are two types of diaphragmatic hernia, one is Congenital diaphragmatic hernia and the second is acquired diaphragmatic hernia.
Small diaphragmatic hernias which don’t cause any symptoms do not require any treatment. Large symptomatic hernias need repair. In most cases this repair is done laparoscopically. A mesh is usually placed to cover the defect and the hernia is repaired. The recovery time after laparoscopic hernia repair is usually very short and patients are back to their normal activities in a week.
Like any other hernia medical treatment does not work for diaphragmatic hernia. The treatment has to be surgical.
With the advent of laparoscopic techniques, the treatment is much simpler these days. The patient undergoes a laparoscopic not a keyhole operation during which the hole in the diaphragm is sutured and it is reinforced with a composite dual layered mesh and thereby a future recurrence of hernia is prevented. The recovery time is very fast. Generally diaphragmatic hernia repair patients go back from the hospital within a day or two and within a week they are able to resume all their normal daily activities.