A hernia occurs when tissue from the abdominal cavity protrudes through the boundaries of the abdomen. Some hernias can be approached with a “wait and see” attitude while some must be repaired quickly to prevent damage to the viscera.
Types of Hernias
The six most common types of hernias are the inguinal, the femoral, the umbilical, the incisional, the ventral and the hiatal. The names reflect the area in which the hernia occurs.
An inguinal hernia occurs in the groin, where the leg meets the trunk. This is the most common type, and there are two variations. The indirect variety occurs when abdominal tissue protrudes through the passage from the torso to the scrotum. The direct variety is found just to the side of this passage, where an area of the abdominal wall has become weak. Because of the nature of inguinal hernias, they occur much more often in men.
Femoral hernias occur when tissue passes through the opening in the body wall that exists to allow the femoral vein and artery to pass into the leg. This type is more common in women because of the wider structure of the female pelvis.
Umbilical hernias, as the name implies, are a bulge of tissue into the umbilicus. Although these hernias are most common in infants, the natural weakness of this area of the abdomen will sometimes also result in hernias in adults.
Incisional hernias occur at the site of an incision or scar in the abdominal wall. Any breach in the abdominal wall will heal leaving a slight weakness in that area. This weakness may give way at some future time, creating an opening through which abdominal tissue may protrude.
A ventral hernia is one that occurs anywhere in the front wall of the abdomen. This is a catchall category for a hernia that does not fit the criteria for one of the other types.
The hiatal hernia occurs at the top of the abdominal cavity. In this case, errant stomach tissue protrudes through the opening in the diaphragm that exists to allow the esophagus to pass through.
Treatment of Hernias
If the determination is made that a hernia needs to be repaired, there are a couple of options: tension and tension-free repair. Tension repair is an older technique that is rarely used today. It involves making an incision in the area of the hernia, pushing the protruding tissue back into place, and stitching the incision closed.
Tension-free repair is the standard of care today. It involves using a piece of synthetic mesh to cover the area of the hernia. The mesh is then stitched to the surrounding tissue, providing a matrix for new tissue growth and repair. This surgery can either be done on the outer surface of the abdomen or from the inside with laparoscopy. The laparoscopic procedure involves several small incisions through which the surgeon inserts the laparoscope and instruments. The protruding tissue is pulled in and the mesh is stitched to the inner wall of the abdomen.
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