Surgery for abdominal wall hernia

An abdominal wall hernia (abdominal hernia) occurs when an abdominal organ emerges from the abdominal cavity.

Content is usually a portion of the intestine or abdominal fatty tissue contained in the thin membrane lining the inside of the abdominal cavity.

About 10% of the population has a hernia during life.
Hernias can occur in infants, children and adults in both men and women. However, abdominal hernias occur more frequently in men.

Abdominal hernias can be divided as follows:
1. Congenital hernia (hernia congenita) – exists since birth and is caused by insufficient formation of part of the abdominal wall; A distinction is made between:

  • Hernia
  • Umbilical hernia
  • Femoral fracture

2. Acquired hernia (hernia acquisita) – is not present from birth and can arise as follows:

  • by overload – especially in adults due to efforts that increase pressure in the abdomen, such as heavy work, chronic constipation, coughing, etc.
  • due to weak points – caused by the relaxation of muscle fibers and connective tissue, occurs mainly in the elderly.


Types of abdominal hernias

Inguinal hernia: It represents 75% of all abdominal hernias.
The inguinal hernia may appear as a swelling in the groin.
It occurs up to 25 times more often in men than in women. This type of hernia is divided into two different groups: direct and indirect hernias.
Both occur inguinally, i.e. at the point where the skin of the thigh unites with that of the abdomen (inguinal ring), but both have a slightly different origin.
The difference between direct and indirect hernia is important for diagnosis.

  • Indirect inguinal hernia: an indirect hernia follows the course taken by the testicles during their fetal development, as they descend from the abdomen into the scrotum.
    This pathway is called the inguinal canal and usually closes before birth. However, it can remain a zone that favors the later formation of a hernia.
    Sometimes the hernial sac penetrates into the scrotum.
    An indirect inguinal hernia can occur at any age.
  • Direct inguinal hernia: The direct inguinal hernia occurs inside the inguinal canal like the indirect hernia, but in a zone where the abdominal wall is slightly weaker and thinner.
    Rarely she enters the scrotum.
    Unlike indirect hernias, which can occur at any age, direct hernias occur almost exclusively in adults and the elderly, because with age, the abdominal wall is weakened.

Femoral hernia: The femoral canal is the pathway through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh.
If the iliac and pubic fascia is weakened, the abdominal contents (usually the intestine) may protrude.
A femoral hernia causes a bulge just below the groin, in the area between the abdomen and thigh.
This disorder usually occurs in women. Femoral fractures can sometimes no longer be repositioned (they can no longer be manually pushed back into place) and pinched.
Not all non-reposable hernias are strangulated (have a reduced blood supply), but all non-reposable hernias must be evaluated by a physician.

Umbilical hernia: this hernia (10-30% of all hernias) is often observed at birth as a protruding navel.
The umbilical hernia is caused by an opening in the abdominal wall that usually closes before birth, but in some cases this does not happen completely.
If it is small (less than one centimeter), this type of hernia usually closes gradually within 2 years.
Large hernias and those that do not close on their own require surgical intervention at the age of 2 to 4 years.
Even if this area closes at birth, the umbilical hernia can appear years later because this area can remain a weak point of the abdominal wall.
Umbilical hernias can also occur later in life in pregnant women or women who have already given birth (due to additional stresses in this area).

Incandicial hernia: Abdominal surgery leads to a defect in the abdominal wall.
This defect can lead to a weak spot where a hernia can develop. This occurs in 5-10% of all abdominal surgeries, but some people are more at risk.
Even after surgical correction, an incisional hernia can recur (recur).

Spieghel’s hernia: This rare hernia occurs along the edge of the rectus abdominis muscle along the Spieghel fascia, which is located a few centimeters to the side of the abdomen.

Obturator hernia: This extremely rare type of abdominal hernia develops mainly in women.
The obturator hernia exits from the pelvic cavity through an opening in the pelvic bone (hip bone hole).
In this case, there is no protrusion, but there may be an intestinal obstruction.
Since no swelling is visible, the obturator hernia is very difficult to diagnose.

Epigastric hernia: It occurs between the navel and the lower thoracic area along the midline of the abdomen.
The epigastric hernia usually contains only fatty tissue and rarely intestines.
It forms in a relatively weak abdominal wall area. The hernias are often painless and cannot be placed in their place in the abdomen.

hernia – The tissue exits through a membrane on the region.

Diaphragmatic hernia – If the hernia originates from a passage of visceral parts through the diaphragm, it already exists at birth, is called a congenital diaphragmatic hernia.

What are the causes of abdominal hernia?

Abdominal hernia can occur for a variety of reasons, including:

  • Heredity – if one or both parents have a hernia, there is a greater chance of developing it.
  • Age – as you get older, the risk of developing a hernia increases.
  • Ehlers-Danlos syndrome is a group of rare genetic diseases that occurs in humans and pets due to a defect in colleague synthesis.
  • Marfan syndrome is a genetic disease of connective tissue.
  • Pregnancy – the maternal muscles stretch and facilitate leakage through the tissues.
  • Drastic weight loss – when overweight people lose weight, they tend to develop a hernia.
  • COPD, whooping cough – the patient has to cough a lot due to lung disease. The cough causes strong pressure in the abdomen. Any disease associated with severe cough can lead to a hernia.
  • A severe flu illness can sometimes cause a hernia.
  • Ascites – accumulation of fluid in the abdomen (abdominal cavity).
  • Through exertion – excessive weight lifting or exercise exercises (bodybuilding) increase pressure on the abdomen and other parts of the body.
  • Surgical intervention – the hernia can occur as a postoperative abdominal complication, for example, after a cesarean section, as the operation leads to weak points in the abdominal wall layers.
  • Excess weight – if a person is overweight, the risk of developing a hernia is much higher than in people without excess weight.

What are the symptoms of an abdominal hernia?

The hernia may be asymptomatic (without symptoms) or cause pain, which may be mild to severe.
Inguinal, thigh, umbilical and incisional hernias can cause some of the following symptoms:

  • A marked swelling of the abdomen or groin under the skin; the swelling may pass while lying down and be painful.
  • A feeling of heaviness in the abdomen.
  • Discomfort or pain in the fracture area, which can radiate into the thigh.
  • Digestive problems.

The pain increases with an increase in abdominal pressure, that is, in the following situations:

  • during physical activities,
  • when standing for a long time,
  • when sneezing or coughing,
  • during bowel movements.

Pain and swelling recede in a lying position.

Complications of abdominal wall hernia

The following complications may occur:

Inflammation – occurs rarely and leads to the formation of adhesions in the hernial sac, i.e. between the peritoneum and leaked intestines.

Intestinal obstruction – a complication of the hernia that occurs when the food consumed accumulates in the leaked part of the intestine and is unable to move further.

Pinching – the most serious complication that occurs when the edge of the abdominal wall opening is compressed by:

  • Tapes
  • Brawn
  • Narrowing of the canal.

Blood circulation is interrupted, as a result the hernated tissue dies and forms a gangrene. After that, perforation of the intestine occurs in this area, and the fecal contents come out. In this way, a serious infection develops: peritonitis.

Diagnosis, how to recognize an abdominal hernia?

An abdominal wall hernia is diagnosed at the medical examination.

The abdominal wall hernia is:

  1. reposable if the contents of the hernial sac can be pushed back into its anatomical seat (in the abdomen) by a manoeuvre of the doctor (by taxis) or return there when the patient lies down;
  2. non-reposable if the hernia cannot be manually pushed back into the abdomen due to inflammation or adhesions. In this case, it is necessary to carefully pay attention to the symptoms, as complications may arise: constipation and pinching of the hernia.

Sometimes apparatus examinations such as ultrasound or X-rays are helpful for the presentation of complications.

Treatment of abdominal hernia

Umbilical hernia in young children usually improves on its own as the muscles become stronger.
However, most abdominal hernias enlarge over time and do not pass without treatment.
Most umbilical hernias in infants close themselves within 18 months.
The doctor can sometimes push the bulge back into the abdominal cavity during the physical examination.
The patient should not try this himself.
Some believe that a natural remedy is to stick a coin with tape on the hernial gate.
However, this “correction” does not help and can cause germs to collect under the bandage, which then lead to infection.

In children, an umbilical hernia is usually operated on if:

  • it causes pain in the abdomen,
  • it is larger than 1.5 centimetres in diameter,
  • it has not decreased after 6-12 months,
  • it continues until the age of 3,
  • parts of the intestine are pinched or occluded.

Surgical intervention for abdominal wall hernia

A reconstructive operation of the abdominal hernia consists in the relocation of the fracture into the abdomen and repair of the weakened muscle.
For this purpose, the following procedures are used:

  • Laparoscopy (a minimally invasive procedure in which the surgeon works through a few small incisions in the abdominal wall)
  • Open surgery (in which a single large abdominal incision is made)

The procedure is performed on an outpatient basis and the patient can return home on the same day.
Practically, the surgeon pushes the hernia tissue to its anatomical seat, and then fixes it with an abdominal mesh.
The net is fastened with a collagen adhesive, so there is no need to set a seam.
Different types of materials can be used for the mesh: synthetic, absorbable, biological, etc.

In general, nowadays one tries to limit anesthesia only to the smallest possible area of the body in order to avoid complications.
Depending on the concomitant diseases of the patient, one can opt
for local, spinal or general anesthesia As a rule, laparoscopy is performed under general anesthesia.

Preventive measures for abdominal wall hernia

To prevent the exacerbation of an abdominal hernia, one should not engage in gymnastics and lifting exercises that exert strong pressure on the abdomen.
In addition, a diet against constipation is important because pressing during bowel movements can aggravate the fracture.

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