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A hernia is the exit of an organ, such as the bowel, through the wall of the cavity in which it normally resides.
All hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot.
Hernias come in a number of different types, most commonly they involve the abdomen, specifically the groin. Most hernias are not immediately life threatening, but they don’t go away on their own and can require surgery to prevent potentially dangerous complications.
An inguinal hernia is the most common type of hernia in adults. Inguinal or groin hernias are more common in men but they may also occur in women. With an inguinal hernia, abdominal contents, most commonly the small bowel (small intestine) or the omentum (a layer of fat that coats everyone’s abdominal cavity), can protrude through the hernia creating a lump or visible bulge. A hernia may cause discomfort or sometimes pain.
Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, almost all of them develop in women because of the wider bone structure of the female pelvis. Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Once these hernias are diagnosed, early repair is very strongly advised before such complications occur.
Umbilical hernia occurs in or around the belly-button, or umbilicus. The belly button is an inherently weaker area of the abdominal wall, likely as a consequence of your umbilical cord coming from this area in utero. Eventually, the fascial layer of the abdominal wall can be worn away, resulting in a hole (a hernia) in the abdominal wall.
An epigastric hernia occurs when a weakness in the abdominal muscle allows the tissues of the abdomen to protrude through the muscle. An epigastric hernia is similar to an umbilical hernia, except the umbilical hernia forms around the belly button and the epigastric hernia is usually between the belly button and the chest.
By far the most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or “defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the spinal discs.
Risk factors for the development of a hernia include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy, among others. Hernias are partly genetic and occur more often in certain families. Hernias can often be diagnosed based on signs and symptoms. Occasionally medical imaging is used to confirm the diagnosis or rule out other possible causes.
If your hernia is growing larger or causing pain, your doctor may decide that it’s best to operate. Hernia repair is recommended for some types of hernias to prevent complications like obstruction of the bowel or strangulation of the tissue. Most abdominal hernias can be surgically repaired, time needed for recovery after treatment is reduced if hernias are operated on laparoscopically.
There are various forms of treatment – open hernia surgery using a mesh to repair the weakness, and keyhole surgery which may enable you to return to normal activities sooner.
Open surgery requires a longer recovery process and you may be unable to move around normally for up to six weeks.
Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions. Laparoscopic surgery is less damaging to the surrounding tissue.
The surgeon has several goals, such as repairing the hernia with a minimum of operative and post-operative discomfort and providing an effective repair. Hernia surgery techniques have evolved a lot in the last few years and allow to maintain the lowest possible recurrence rate. Today, most people who have hernia repair surgery are able to return to their normal activities within a few weeks-and sometimes within a few days-of surgery.
Surgical complications include pain that lasts more than three months, surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence.
It’s important to recognize the early signs of a hernia. An untreated hernia will not go away on its own and it can also put too much pressure on nearby tissues, which can cause swelling and pain in the surrounding area.
If the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal tissue to become infected or die. A strangulated hernia is life-threatening and requires immediate medical care.
It is important to provide your medical information to our team, including any nonsteroidal anti-inflammatory medication (NSAID) that you currently take, even aspirin or ibuprofen.
Before surgery, make sure to follow any pre-appointment restrictions set by your surgeon, such as avoiding nonsteroidal anti-inflammatory medications for a week before surgery and not eating the day of surgery. Try to get a good night’s sleep, and if your procedure requires a hospital stay, make sure to bring anything you will need during that time.
When you return home after surgery, follow your surgeon’s instructions regarding when you can return to your normal daily activities. The amount of pain and/or discomfort you experience depends on the location of the hernia, the type of repair, and your personal pain tolerance level. Generally, walking and climbing stairs may be difficult for a day or two.
A post-operative visit is required with a doctor in 7-10 days following the surgery. At this time, all stitches will be removed and your progress in healing will be checked.