A column by Nicholas Verdura, MD
One of the most frequently performed operations by general surgeons worldwide is the repair of an abdominal wall hernia. Approximately one million hernia operations are performed each year in the U.S.
Hernias are abnormal bulges created by a weakness or hole, usually in the abdominal wall or groin. A hernia can also be defined as an exit of an organ, such as a bowel, through the wall of the cavity in which it normally resides. A localized bulge in the abdomen or groin caused by a hernia is a common problem that can range from pain-free to painful.
Hernias can be congenital, which are present at birth, or can develop secondary to tissue weakness in the abdominal wall or groin.
Activities and medical problems that increase the abdominal wall pressure can also lead to a hernia. Some examples of these are straining due to long-term constipation issues or urinating, persistent cough, lifting heavy items and physical exertion. Poor nutrition, chronic obstructive pulmonary disease, obesity, pregnancy, previous surgeries (specifically open surgeries) and smoking are also some risk factors for the development of a hernia.
There are many types of hernias including inguinal, femoral, hiatal, umbilical, ventral and incisional. These hernias can range from reducible, in which the hernia is able to be pushed back into its original location, to incarcerated, where the hernia is now unable to be returned to its normal location, to strangulated, in which now the blood supply to the herniated content can be jeopardized.
As a hernia progresses, elective surgery becomes more urgent and once the hernia becomes strangulated, surgery becomes an emergency.
In many scenarios, patients may have hernias and have only painless swelling. However, a hernia can cause discomfort and pain, with symptoms often becoming worse with certain activities or movements. Patient’s should nonetheless see their physician for evaluation, and seek immediate attention if nausea and vomiting along with increasing pain develops.
Many times, a hernia diagnosis is able to be made by a physician during a physical exam. However, there are times that the hernia is difficult to see and a radiologic test like a CT (computerized tomography) scan or ultrasound may be ordered to help with the diagnosis.
There are several different avenues for surgical repair, including open surgery and minimally invasive laparoscopic (using small incisions with a laparoscope) approaches.
Many procedures now utilize mesh to lower the recurrence risk. Surgeries are performed under general anesthesia the majority of the time and on an outpatient basis, so patients are able to go home the same day as the surgery is completed.