Abdominal Hernia

What is an Abdominal Hernia? 

An Abdominal Hernia is a quite common disease, occurring in about 25% of men and 3% of women. It involves the pathological movement of the hernia, i.e, parts of the peritoneum, intestines, or sometimes even the stomach, through defects in the abdominal wall. These hernias are divided into two types:

• Congenital, i.e., openings that did not close properly during development, such as an umbilical or indirect inguinal hernia
• Acquired, i.e., weak points in abdominal wall muscles that occurred after intrabdominal pressure increased such as pregnancy, sneezing, and constipation, or after a previous surgery as in the case of direct inguinal, femoral, or incisional hernias

 Abdominal Hernias – Causes 

Abdominal hernias start as weakness in the anterior abdominal wall that may be congenital or acquired. Over time, that weak point becomes unable to support the contents of the abdominal cavity resulting in an opening through which the hernia protrudes. Any condition that increases intraabdominal pressure can increase the risk of abdominal hernia formation. The most common risk factors are:

• Male gender
• Aging
• Obesity
• Lifting heavy objects
• Competitive sports
• Sedentary lifestyle
• Previous abdominal surgeries, especially if complicated by surgical site infection
• Multiple pregnancies, especially in the case of cesarian section deliveries
• Past injuries to the abdomen
• Smoking
• Connective tissue diseases
• Diseases associated with increased sneezing, coughing, constipation, and urination
• Weaknesses in the transverse fascia
• Steroid medications
• Ascites 

Abdominal Hernia – Types

There are several types of abdominal hernia, depending on location:

• Inguinal hernia – the most common abdominal hernia, occurring mostly in men and involves the hernial sac moving into the groin area. This hernia is congenital in children, while in adults it is always acquired
• Femoral hernia – this is more common in women and involves the pathological movement of the hernial sac into the upper medial thigh
• Umbilical hernia – this is most common in newborns, though it can present in adults as a periumbilical hernia. It involves movement of the hernial sac through the opening around the navel that normally closes during development
• Epigastric hernia – this involves the movement of the hernial sac through the “linea alba” which is a line of white tendinous tissue that stretches along the midline of the body from the xiphoid process of the lower sternum to the pubic symphysis and is the attachment point for abdominal wall muscles
• Incisional hernia – this involves the movement of the hernial sac through a scar, usually from previous abdominal surgery
• Hiatal hernia – this is an internal hernia where part or all of the stomach moves into the chest cavity through a weakness in the esophageal opening of the diaphragm

Abdominal Hernia – Diagnosis

Abdominal hernias are diagnosed by careful palpation, during which a physician looks for a characteristic subcutaneous bulge, or thickening around the abdomen, groin, or upper thigh. Initial symptoms are usually discomfort, a pulling sensation, or pain during exercise or physical activity. These are often exacerbated by coughing, sneezing, or passing stools, i.e., anything that increases intraabdominal pressure. Additional imagining studies, usually an ultrasound but sometimes CT or MRI, are sometimes needed to better assess the stage and severity of the disease. This is especially true in the case of internal hernias. Incarceration refers to the failure of the hernial sac to spontaneously return to the abdominal cavity. This may compromise blood flow, leading to a process called strangulation, a potentially fatal complication that requires immediate surgical intervention.

Abdominal Hernia – Treatment

Surgery is usually the standard for treating abdominal hernias, except for umbilical hernias in children, which usually spontaneously resolve by 3 years of age.

Abdominal hernia surgeries can be performed via two methods:

• Tension, where tissues are sutured together to close the hernial opening
• Tension-free, where a special medical mesh is placed to block the opening of the hernia from the inside. This method also minimizes the risk of recurrence in larger hernias

Abdominal hernia repair can be performed using classic (open) or minimally invasive techniques, such as laparoscopic or robotic surgery. The operation is done under local or general anesthesia and, depending on the size and location of the hernia, can last between 30 minutes and 2 hours. Minimally invasive techniques avoid making a large incision in the skin. Instead, access is achieved using only 3-5 much smaller incisions, whose diameter is less than 1cm. These tiny openings serve as gates for all the surgical instruments, including an endoscopic camera to properly visualize the area. Next, the surgeon identifies the defect and closes it, placing a special medical mesh underneath the defect to strengthen the abdominal wall if needed.  Sometimes laparoscopy is challenging or impossible to perform in patients with a history of previous surgeries, difficult physical access, or an unusual hernia location. Robotic surgery can overcome all of these obstacles and effectively treat even the most challenging hernias. Minimally invasive surgery offers patients several key advantages over classic, open techniques. Namely, there is less intraoperative blood loss and a lower risk of surgical site infection. The postoperative recovery period is also shorter and less painful, allowing patients to return to their daily routines sooner. Finally, scars are often barely visible when healed, achieving a vastly superior cosmetic effect for patients as compared with classic, open surgery.

Abdominal Hernia – Recovery

Hospitalization after abdominal hernia repair depends on the location of the hernia, the extent of the procedure, and the method used. However, one can expect to remain hospitalized for about 1-3 days. The recovery period ranges from 4 to 6 weeks, during which patients must avoid lifting heavy objects and intense physical exertion, including sexual intercourse.

Abdominal Hernia – Price

The price of an abdominal hernia repair depends on the type of hernia, its location, the type of mesh used to reinforce the abdominal wall, the type of anesthesia used (local or general), and whether it is done classically, laparoscopically, or robotically. All details of the operation and possible treatment options are always discussed together with the attending physician during the initial consultation where you are qualified for the procedure.