Hernia Repair

Hernia overview

Definition
A hernia is usually a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the fascia, the strong layer of the abdominal wall that surrounds the muscle.

The types of hernias are based on where they occur:

• Inguinal hernia appears as a bulge in the groin. This type is more common in men than women. The bulge may go all the way down into the scrotum.
• Femoral hernia appears as a bulge in the upper thigh. This type is more common in women than men.
• In a hiatal hernia, part of your stomach pushes up into an opening (the hiatus) in your diaphragm. The diaphragm is the muscle between your stomach and your chest.
• Incisional hernia can occur through a scar if you have had abdominal surgery in the past.
• Umbilical hernia appears as a bulge around the belly button. It occurs when the muscle around the navel doesn't close completely.

Alternative names
Hernia - inguinal; inguinal hernia; rupture

Causes, incidence and risk factors
Usually, there is no obvious cause of a hernia. Sometimes, they occur with heavy lifting. Hernias may be present at birth, but the bulging may not be noticeable until later in life. Some patients may have a family history of hernias.

Hernias can be seen in infants and children. This can happen when the lining around the abdominal organs does not close properly before birth. About 5 out of 100 children have inguinal hernias (more boys than girls). Some children may not have symptoms until they are adults.

Any activity or medical problem that increases pressure on the abdominal wall tissue and muscles may lead to a hernia, including:

• Chronic constipation, straining to have bowel movements
• Chronic cough
• Cystic fibrosis
• Enlarged prostate, straining to urinate
• Extra weight
• Heavy lifting
• Undescended testicles

Symptoms
Most often there are no symptoms. Sometimes, however, there may be discomfort or pain. The discomfort may be worse when you stand, strain or lift heavy objects.

Signs and tests
A doctor can confirm the presence of a hernia during a physical exam. The mass may increase in size when coughing, bending, lifting or straining. The hernia (bulge) may not be obvious in infants and children, except when the child is crying or coughing.

Treatment
Surgery is the only treatment that can permanently fix a hernia. However, smaller hernias with no symptoms can sometimes be watched. Surgery may have more risk for patients who have serious medical problems.

Surgery will usually be used for hernias that are getting larger or are painful. Surgery secures the weakened abdominal wall tissue (fascia) and will close any holes.

An umbilical hernia that fails to heal on its own by the time your child is 5 years old may be repaired.

Emergency surgery is sometimes needed. The sac containing the intestine or other tissue may become stuck in the hole in the abdominal wall. If it cannot be pushed back through, this can lead to a strangulated loop of intestine. If left untreated, this portion of the intestine dies because it loses its blood supply.