A hernia is simply a defect in the fascia of the abdomen that allows the contents of the abdomen cavity (fat, intestine, etc.) to push through, often causing a visible or palpable bulge. There are several different forms of hernia depending on where they are located. Hernias are very common, with estimates that upwards of 25% of all men will develop an inguinal or groin hernia during their lifetimes. With only approximately 800,000 of these repaired every year, it is clear that millions of men live with hernias and don’t even know it. However, hernias are not limited only to men; women can also develop hernias. Contrary to what we commonly believe, heavy lifting is not the only reason why hernias form. Genetics, intra-abdominal pressure from obesity or pregnancy, connective tissue disorders, smoking and more can all contribute to the risk of developing a hernia.
Hernias are not dangerous in and of themselves. However, if the contents of the hernia – usually intestinal tissue – get stuck within the hernia defect, this can lead to an emergency situation. There are two critical concerns: First is incarceration, when a hernia cannot be reduced back into the abdomen either by lying down or gently pushing on the protruding tissue. This means that the musculature and tissue around the hernia are tightly surrounding the organ. This can lead to strangulation, meaning blood flow is cut off to the hernia contents. If this is not addressed emergently (within a few hours) the trapped tissue can die. In the case of intestinal tissue, this would require not only hernia surgery to repair the defect but also a colectomy or colon resection to remove the diseased, dead portion of the large intestine.
There are various forms of hernias and they are generally classified by either their location in the abdomen or what caused the hernia:
- Inguinal or groin hernias occur mostly in men and happen in or around the lower-left or lower-right crease of the groin where the abdomen meets the legs. Groin hernias can be present on both sides of the body at the same time – known as bilateral inguinal hernias.
- Femoral hernias present mostly in women and tend to protrude into the upper thigh
- Umbilical hernias occur at the belly button and are often caused by pregnancy, congenital factors, or excess weight
- Incisional hernias occur as a result of a puncture, usually from surgery, that reopens due to pressure from the abdomen
- Hiatal hernias are not true abdominal hernias. This is where the hiatus — or hole through which the diaphragm passes, enlarges, usually due to excess weight, allowing the upper part of the stomach to push through and often causing acid reflux
- It is also important to mention sports hernias which are actually tears in the soft tissue and not a hernia proper. Typically, however, sports hernias are repaired in the same way as inguinal hernias and mimic many of their symptoms
Hernia Repair and Treatment
If you scour the Internet, you will find plenty of stories about how a hernia was repaired without surgery, either using compression techniques or custom-made hernia belts. Unfortunately, this is poor advice, and following it can actually make the situation worse. In fact, hernias are a progressive condition, meaning they only get larger and more difficult to repair. Surgical repair is the only viable option for closing the defect. Hernia surgery is most effective when performed prior to any complications, such as incarceration or strangulation. Its outcomes are further improved when employing a very experienced and skilled surgeon who specializes in the repair of hernias.
Hernia repairs performed using traditional laparoscopy or robotically assisted techniques are typically very successful, and the recurrence rate using modern techniques including mesh is about 1-2% versus significantly higher recurrence rates when not using mesh.
To learn more about hernia repairs, please contact Dr. Higa for a consultation