What is Abdominal wall Hernia

A hernia is a protrusion of an abdominal organ or abdominal far through the wall (abdominal wall) that contains it. There are many types and are usually classified by where they are or their cause. Hernias can develop due to increased pressure in the abdomen, muscle weakness or a combination of the two. The National Institute of Diabetes and Digestive and Kidney diseases (NIDDK) show that hernias affect 5% of the population at certain point in their lives. How they are treated depends on their location and size.

Abdominal wall hernias can be classified according to their location along the abdominal wall:

Ventral hernias

Ventral hernias are hernias that occur in the anterior abdominal wall and include epigastric (above the belly button), umbilical (around the belly button), spigelian (along the side of the abdominal wall) and incisional hernia (hernias that occur at previous incision sites).

Groin hernias

Groin hernias are hernias that occur in the groin region, the area of the abdomen where the thigh meets the hip region. This includes inguinal and femoral hernias.

Inguinal hernias are common in men;
Femoral hernias are common in women;

Pelvic hernias are hernias that protrude through the pelvic floor including sciatic, obturator and perineal hernias.

Flank hernias

Flank hernias are those that protrude the muscles of the back wall.

Who is at risk for an abdominal wall hernia?

what are the risk factors ?

Certain individuals may be more prone to abdominal hernias. These include:

Individuals with connective tissue disease
People with genetic predisposition to develop abdominal hernias
Previous abdominal surgery
Increase in intraabdominal pressure
Excessive physical training and coughing
Obesity
Smoking (weakens the connective tissues)
Diabetes (it affects wound healing if present)
Old age (muscle denegeration)
Male gender have higher chances of developing inguinal hernias

What are the symptoms of an abdominal wall hernia?

Hernias can develop with certain symptoms, which can evolve slow or fast in intensity. The presentation is often dependent on the size and location of the hernia. Symptoms may include:

Asymptomatic: No visible or noticeable symptoms at all
A bulge in the abdominal wall, visible when coughing or straining
Pain and discomfort in the region of the hernia, especially while doing sports or lifting weights
Pressure symptoms to the overlying skin including redness and ulcers
Sometimes the contents of the hernia can get stuck and lead to a blockage or affect the blood supply to the organ.
Blockage of bowel also known as obstruction. If the hernia contains part of the intestinal tract such as the bowel. In such instances the individuals may experience severe pain, vomiting and constipation. This is often an emergency and patients may require emergency repair of the hernia

How is an abdominal hernia diagnosed?

Most hernias can be diagnosed by physical examination. Palpation usually helps doctors identify hernias.

Small hernias or those in the pelvis may be difficult to diagnose and may require further diagnostic imaging. Imaging may also be necessary in obese patients or those with large hernias to delineate the anatomy. In such instances an ultrasound or CT scan would be the best form of imaging. In some situations, MRIs might provide better imaging of the area. Doctors determine easier the hernias severity and state of surrounding structures.

What are the consequences of not undergoing treatment?

The main consequences of not undergoing surgery include:

The inability to push the hernia back into the abdominal cavity also known as irreducible or incarcerated hernia

Once a hernia is irreducible there is also to the blood supply of the fat or organ protruding through also known as strangulation. This can be a life threatening condition.

In certain instances when the blood supply to the organ such as the bowel is affected; the organ may perforate. This is when there is a hole in the bowel leading to an emergency operation.

It is vital to seek medical attention if pain from the hernia becomes significantly worse, one can no longer reduce/push the hernia back in, it is painful to touch and there are noticeable changes to the overlying skin.

What are the treatment options?

Abdominal hernias do not always need to be treated. The need for treatment is dependent on various different factors including severity of symptoms, health of the patient, type of hernia and progression of size. Treatment options include:

Conservative/ non-operative management. If the patient has no symptoms from the hernia, surgical intervention is not necessary. However it is important to seek medical attention at any point if you are concerned about symptoms or have noticed a sudden worsening of symptoms. Doctors will observe and intervene if needed.

Lifestyle changes such as weight loss, avoiding heavy lifting and managing better chronic cough or constipation. Such changes prevent hernias from worsening.

Surgical management. If the patient experiences any of the aforementioned symptoms surgery may be recommended.

How is procedure performed?

Treatments options for abdominal wall hernias in London

Hernia repair involves pulling the hernia back into the abdomen and repairing the defect or weakened muscle wall. This can either be done with an open incision or key hole surgery also known as laparoscopic surgery.

Open surgery: During this operation, an incision will be made over the hernia site such as in the groin or abdomen. The tissue protruding through (organ or fat) will then be pushed back into the abdomen and the weakened area also known as the defect will be sutured. In some instances, particularly in the groin a mesh will be used to reinforce the weakened area. This can be done with the patient asleep i.e. under general anaesthetic or under local anaesthetic as well.

Laparoscopic surgery: This will be performed under general anaesthetic. Smaller but multiple cuts, usually 3 are made on the abdomen and air is inflated to created space in the abdomen. An instrument with a small camera is then inserted into the abdomen. This camera is then used to direct other instruments in the abdomen to pull the hernia back into the abdomen and repair the weakness in the abdominal wall. A mesh may or may not be used depending on the size of the hernia and its location.

Benefits of laparoscopic surgery

Small incisions, barely visible scaring;
Less postoperative pain and faster recovery;
Optimal for different types of hernias;

What are the risks of hernia surgery?

Infection
Pain
Hernia recurrence
Intraoperative or postoperative bleeding
Collection of fluid or blood in the wound (seroma or haematoma)
Recurrence of the hernia and need for further surgery
Scarring in the abdomen also known as adhesions
Complications related to a prolonged operation/anaesthetic including clots in the legs, lungs, brain or heart.

Abdominal wall hernia surgery recovery

How long will I be in hospital and what is the recovery period and follow up?

This is a valid question, often raised by patients.

After hernia surgery, the course of recovery is as follows:

You should be able to go home the same day or the say after as long as the operation is without complications.
1-2 weeks before going back to work
No heavy lifting or strenuous activity for 6 weeks
Can go back to a normal diet immediately after surgery
Patients will undergo a follow-up 4-6 weeks after surgery

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