Abdominal surgery

Abdominal wall hernias

What are abdominal wall hernias?

When the abdominal contents protrude through the muscle and strong abdominal wall that surrounds it, this is called a hernia. In the abdomen, various forms of hernias can occur. A hernia of the abdominal wall is a protrusion of the abdominal contents through a weakening or defect in the wall, which can be acquired or congenital (present since birth).

Many hernias go unnoticed, but some become incarcerated or strangulated, producing pain and necessitating surgical intervention urgently. The diagnosis is made based on clinical examination, but in some cases, ultrasound and or CT scan may be helpful in surgical planning. A surgical repair is the only treatment option.

Types of abdominal wall hernias

Abdominal wall hernias include:

  • Umbilical hernias – A weak point at the umbilicus may cause a little fat, fluid, or intestine to push through, causing a lump or bulge near the belly button. Most but not all umbilical hernias need to be repaired. If the defect is small and contains only extraperitoneal fat, it can often be managed conservatively. If there is abdominal content such as bowel in the hernia, it will need to be repaired.
  • Inguinal hernias - These hernias are by far the most common form of abdominal wall hernias. They develop in the area where the blood vessels and other structures to the testis exit the abdominal wall. In females, a similar defect is present, although there are no structures that exit the abdominal cavity. Inguinal hernias have a high chance of strangulation and always warrant repair.
  • Femoral hernias - This is a rare type of hernia, also in the groin area and always creates diagnostic and therapeutic difficulties. All femoral hernias will need elective repair.
  • Epigastric hernias - A weakening region in the abdominal wall permits a small amount of fat to push through the abdominal wall, resulting in an epigastric hernia. Typically, epigastric hernias are small. They develop in the area between the belly button and the breastbone in the centre of the belly. Epigastric hernias have a low risk of incarceration and can often be managed conservatively (observation only).
  • Spigelian hernias - Spigelian hernias are super rare and can be seen anywhere along the Spigelian fascia line. Spigelian hernias, unlike other types of hernias, stay trapped between the layers of the abdominal muscles rather than pushing through all the beneath layers of the abdominal wall. As a result, Spigelian hernias may not appear as a bulge or lump right away. Eventually, they will cause symptoms and will always need to be managed surgically.
  • Incisional hernias - An incisional hernia is a hernia that develops in the region of prior surgery. These hernias develop after surgery has weakened the abdominal wall or when a surgical incision becomes infected, further weakening the area. Most incisional hernias will increase in size and eventually need surgical repair.
  • Parastomal hernias - When a defect between a stoma and abdominal wall causes a hernia, it is referred to as a parastomal hernia. These hernias are complex and difficult to repair. Sometimes they can be managed conservatively.



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Abdominal wall hernia treatment

Treatment of abdominal wall hernias depends on the type and the symptoms. If you have an abdominal wall hernia with no symptoms, you may not need any treatment. Larger hernias or hernias that are causing pain, on the other hand, may require surgical correction to ease pain and avoid problems. Surgical consultation on whether repair is advisable is mandatory. Open and minimally invasive surgery are the two forms of surgical hernia repair.

  • Open surgery: The surgeon will make an incision in the area of the hernia and then push the protruding tissue back into your abdomen. The weakened area will be closed and almost always reinforced by a mesh.
  • Minimally Invasive Surgery: The surgeon will make a few small incisions in your abdomen during this surgery. Then gas insufflation is used to expand your belly, making it easier to see your interior organs. A short, narrow tube will then be inserted into one of the incisions in your abdomen by the surgeon. A tiny camera, or laparoscope, is attached at the end of this tube. Your surgeon will be able to introduce surgical equipment via the other incisions in your belly, using the camera as a guide. The hernia will then be fixed by covering the defect with a mesh.

 

FAQ

1When is surgery indicated?
If you experience swelling and a bulge that may be pushed back into your abdomen, you may have a hernia. It is important to properly diagnose the type of hernia and assess the risk of incarceration. Incarceration is the entrapment of abdominal contents in the hernia sac and is a surgical emergency.
2What does recovery entail?
The common types of hernia repair will take about two weeks to get back to normal physical activity. Patients are strongly advised not to drive a vehicle themselves for at least ten days. Full recovery to physically strenuous exercise and contact sports takes six weeks. In some instances, there is a slight recovery advantage for laparoscopic or minimally invasive procedures.
3How long does surgery take?
The common types of hernia issues can be treated as a day case. That means admission and discharge on the same day. The surgery usually takes between 45 minutes to an hour. This also depends on the type of hernia.