Types of Hernias

Hernia is defined as a protrusion of the intra-abdominal viscus or part of it through a weak spot outside the abdominal wall. Most abdominal wall hernias are caused by an area of weakness in the abdominal walls.

Hernia often looks like a small or larger bulge under the skin and is caused by the increase of the intra-abdominal pressure and the existence of some “weak” spot in the abdomen area.

The “weak” spots of the abdominal wall include orifices, which allow the passage of corresponding anatomical elements. Hernial orifices can be present in any abdominal area with reduced resistance to the intra-abdominal pressure or where the wall is weakened, due to a congenital malformation, due to age or due to some previous surgical trauma.

When the intra-abdominal pressure increases we have the creation of a gap, which can facilitate the passage of some viscera (usually a segment of intestine or intra-abdominal fat (visceral body fat)).

A hernia may be congenital or acquired. The congenital hernia is appeared prenatally or in infants and is caused by a congenital defect. The acquired hernia may be appeared later, usually during adulthood and is caused by conditions that increase the pressure in the abdominal cavity (obesity, coughing, straining), from previous surgical procedure (incisional hernia) or from trauma.

 

Types of Hernias

There are different types of abdominal hernias, based upon their location and are distinguished into:

 

Inguinal Hernias (or Groin Hernias)

A hernia that occurs in the inguinal canal (inguinal hernia) is by far the most common type of abdominal wall hernia. It accounts for the 75% of all hernias and affects men more often than women. Hernia may appear on the right or left side and can be either indirect or direct or “pantaloon (saddlebag)”, where a direct and an indirect inguinal hernia coexist on the same side. If the hernia sac and its content reach up to the scrotum, then it is called inguinal scrotal hernia.

 

Umbilical hernias

It appears in the area of ​​the navel (bellybutton) or near it in the form of a lump. Umbilical hernias account for approximately 10 – 15% of all hernia cases and are likely to develop in both sexes, especially in women during the post-pregnancy period. It often causes pain and discomfort, while in advanced cases it can cause disorders of the digestive system. Umbilical hernias also occur in those with health issues that cause increased pressure in the belly. Those issues may include obesity, pregnancy, chronic coughing or constipation, and difficulty urinating.

 

Epigastric hernias (White Line Hernias)

They are located in the upper part of the navel, on the so-called “white line” or “linea alba” in Latin (between the sternum and the navel). Some daily habits, such as manual work or sudden weight lifting are the most common cause of hernia in this area.

Femoral hernias

It is the rarest type of hernia and is appeared in the inguinal region (along with inguinal hernias, umbilical hernias, etc.) in the form of a lump in the femoral ring. Although femoral hernia is very rare, it is quite dangerous, as the chances of complication (hernia strangulation) are increased at this point, due to the limited space. Femoral hernia has a male to female ratio of about 1:3.

 

Incisional hernias

Incisional hernias are a common phenomenon in patients who have undergone surgery in the abdominal area. The incisional hernia is a protrusion of tissue that forms at the site of a healing surgical scar and it happens when the surgical cut in your abdominal wall doesn’t close properly after surgery. This can cause your abdominal muscles to weaken, allowing tissue and organs to form a hernia.

 

Causes of hernias

As mentioned above, a hernia occurs when the intra-abdominal pressure increases and creates a gap in some “weak” (vulnerable) point of the abdominal wall, from where a part of abdominal viscus usually protrudes.

Listed below are the factors that usually cause an increase in intra-abdominal pressure:

• Obesity
• Chronic cough
• Constipation
• Smoking
• Prostate Hypertrophy
• Chronic Obstructive Pulmonary Disease (COPD)
• Multiple pregnancies
• Ascites (Fluid Accumulation in the Abdomen)
• Sudden or repeated heavy lifting
• Strenuous physical activity

 

Symptoms & Complications

Many times, an abdominal wall hernia shows no symptoms, at least in its initial stage. Many hernias remain asymptomatic for a long time, perhaps even years. As a result of this, sufferers often postpone the treatment of their hernia, as long as it does not cause them any discomfort. This decision, however, entails serious risks, as no abdominal wall hernia, no matter how small it is, it can’t be characterized as harmless. The possibility of strangulation (an extremely serious complication of a hernia) is not rare and cannot be predicted when it will occur. But when it happens, it can put the patient’s health at serious risk.

 

Strangulated Hernia is a serious medical condition that occurs when the intra-abdominal viscus becomes permanently trapped within the hernia sac, making it impossible to push it back into the abdominal cavity. In a strangulated hernia, the herniated tissue is tightly constricted by the surrounding muscles or tissues, which can lead to ischemia, or inadequate blood flow. This can cause the affected tissue to become deprived of necessary oxygen and nutrients, leading to cell death or necrosis.

Strangulated hernia is a medical emergency that requires immediate surgical intervention due to its potential to cause severe and life-threatening complications to the patient’s life.

 

The alarm symptoms of strangulated hernia are the following:

• Fever
• Nausea & vomiting
• Inflammationand color changes in the skin near the hernia
• Burning feeling around the hernia
• Redness and local heat
• Tachycardia
• Abdominal pain
• Inability to pass gas
• Severe constipation or an inability to have a bowel movement

 

Treatment of abdominal wall hernia

Abdominal wall hernias are treated by a Specialist General Surgeon. It is important for the patient to know that there is no conservative way to treat a hernia and the only appropriate treatment is surgery.

Abdominal hernia repair surgery has evolved alongside surgical science due to the enormous scientific interest in this field. Therefore, today we have a multitude of modern techniques that have simplified the surgical procedure. Now the patient leaves the hospital on the same day of the surgery and is able to continue almost all of his/her daily activities from the next day.

 

The Surgeon who will perform the surgical operation should inform the patient about all the available options of the minimally invasive surgeries (laparoscopic and robotic surgery). After the surgeon has assessed the case and the patient has done the necessary diagnostic tests, then he will suggest the most suitable method for the patient. Contact with the Specialist General Surgeon and CEO of Surgishape Medical Clinic, Dr. Themistoklis Galanakis, and get fully informed about the treatment of any type of abdominal wall hernia.