Abdominal wall hernias – a common correctable condition – Daily Press

Abdominal wall hernias are common abnormalities that exist in up to 10% of the population.

Although they can be present at any age, including infants, the likelihood of occurrence increases with maturity. A hernia is one of the main causes of sick leave and disability. Although surgery is normally a cure, in some cases life-threatening complications can lead to death.

Hernias develop when an internal structure, such as the intestine, breaks through a small space in the musculature of the abdominal wall and forms a sac-like structure. This bulge is usually apparent externally. The location and size of the abnormality determines whether symptoms will develop.

Today, treatments vary depending on the size and severity of the hernia. Some are closely monitored and may not require any therapy. For those who are larger, have significant symptoms, and can potentially strangle, surgery is the only option.

The most common types are:

Inguinal: About 75% of abdominal hernias occur near the groin, where part of the intestine or fat presses through the inguinal canal. Men are more often affected than women. Due to the potential risk of interrupted blood flow to the stuck bowel outside the abdomen, most inguinal hernias need to be repaired.

Umbilical: These arise at a weak point in the abdominal wall near the navel; a segment of intestine protrudes through the defect creating a hernial sac. The affliction occurs more frequently in infants, but usually resolves by age three or four; if it does not go away, surgery may be needed. Umbilical hernias can also occur in adults due to being overweight, chronic cough or constipation and pregnancy. If symptomatic, treatment will usually be needed.

Incisional: When tissue presses on a scarred site from a previous surgery, a hernia can develop. They are relatively common, vary in size and can occur weeks, months or years after an operation. They do not disappear spontaneously.

Femoral: Presenting in the groin area, the intestine protrudes into the femoral canal forming a hernia. They mainly affect older women, are less common than inguinal hernias and prone to complications. After being diagnosed, surgery is usually advised.

Epigastric: Located in an opening in the muscles or tendons of the upper abdomen, these hernias are small and often asymptomatic. When discovered, surgical treatment is recommended.

Spigelian: These relatively rare hernias form in the middle of abdominal muscle fibers. They are equally prevalent in men and women and are more likely to occur later in life. Diagnosis can be difficult because spigelians tend to be small and produce symptoms that can mimic other abdominal disorders. Since they are prone to having complications, removal is usually suggested.

Abdominal wall hernias are classified by when they occur:

  • “Acquired” hernias are induced by life activities such as muscle fatigue, obesity and childbirth.
  • “Congenital” hernias occur in areas of weakness in the wall present from birth.

Hernias are also grouped according to their ability to be either “reduced” manually by pushing the hernia sac back into the abdomen, or “non-reducible” when the pouch containing the intestine cannot be manipulated. This latter situation can be life-threatening. The hernia may become “strangulated” or “incarcerated” with the bowel’s blood supply cut off. Emergency surgery is needed to prevent gangrene.

Abdominal wall hernias do not always produce dramatic symptoms.

In young children, increased irritability may be the only manifestation. In adults, exercise, coughing, or straining while lifting can cause pain or a burning sensation. For the clinically dangerous strangulated hernia, marked discomfort is associated with a toxic appearance of the affected individual.

Since most hernias are visible and can be felt, diagnosis is primarily based on a doctor’s physical examination. If uncertain, particularly in the presence of unexplained symptoms, imaging procedures such as ultrasound, CT scan, or MRI may be indicated.

Hernias have plagued mankind for millennia.

The earliest accounts date back to ancient Egypt. In one tomb there is a depiction of a man’s inguinal hernia being reduced. The ancient Greeks called the condition “hernios”, which means bud or branching. During these eras, different devices and some primitive operative techniques were used. Simple reparation meant castration; strangulation was a death sentence.

It was not until the anatomical discoveries of the Renaissance that hernia treatments began; additional knowledge did not initially improve results. After the introduction of anesthesia and aseptic techniques in the 19th century, new surgical methods emerged. A turning point came in the 1930s with the use of prosthetic mesh in the repair process.

Today, treatments vary depending on the size and severity of the hernia. Some are closely monitored and may not require any therapy. For those who are larger, have significant symptoms, and can potentially strangle, surgery is the only option.

The operative procedure involves either pushing the hernia back into the abdominal cavity or removing the sac and closing the abdominal wall space with stitches. A mesh is placed over the affected area to prevent it from happening again.

There are two types of surgical techniques currently used:

  • In open surgery, the procedure is performed through an incision made at the site of the hernia.
  • In minimally invasive surgery (also called laparoscopic or keyhole surgery), the surgeon inserts a miniature television camera and instruments into the abdomen through a small incision to repair the hernia.

Both techniques can correct all types of hernias. Which one to use in a particular scenario is based on the surgeon’s assessment, clinical circumstances, and patient preference.

A truss or belt was popular in the past to hold the hernia pouch in place and relieve discomfort. Although they may provide temporary relief, these devices are no longer recommended as they fail to treat the underlying hernia and can cause pressure sores.

The risk of getting an abdominal wall hernia can be reduced by maintaining a healthy weight, eating well to counteract constipation, avoiding heavy lifting, and quitting smoking. But if someone develops, modern surgery can provide relief.

Stolz is a retired physician and author of “Medicine from Cave Dwellers to Millennials.”

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