Abdominal Wall Hernias & Reconstruction

An abdominal wall hernia occurs when an organ or tissue protrudes through the wall of muscle that encircles it. It would seem improbable that this could happen in the abdominal wall, which is thick and tough, but there are areas of weakness where a previous opening has closed.

There are several types of abdominal hernias.

While these hernias can occur in people at any age, even in infants, the risk tends to increase as you age. Most abdominal wall hernias are caused by an area of weakness in the abdominal walls.

There are lots of conditions and factors that can create this weakness in the wall:

• Aging
• Chronic coughing
• Frequent heavy lifting
• Genetic defects
• Obesity
• Straining during bowel movements or urination
• Previous hernias
• Infection, especially after surgery
• Abdominal injuries
• Pregnancy
• Surgical openings
• Collagen vascular disease

These hernias generally will show themselves through a lump or bulge under the skin. In most cases, these hernias don’t cause any other symptoms beyond mild pain or discomfort. This can usually be felt when you are straining, such as when lifting something heavy or coughing. Hernias in this stage can usually be pushed back in.

When a hernia becomes incarcerated, the bulge cannot be pushed back in or reduced, and there typically is more pain.

If a hernia becomes strangulated (where the blood supply to the tissue is cut off) you can experience severe pain, nausea, vomiting, and/or redness in the area of the hernia. If this happens, you need to see a doctor immediately — strangulated hernias are life threatening.

There are different types of these hernias. Here are some more common types.

• Epigastric hernia — An epigastric hernia occurs when a weakened area in the abdominal wall allows a bit of fat to push through. These occur in the middle of the belly, between the belly button and the breastbone. Epigastric hernias usually don’t cause any symptoms, although there may be some pain in the upper belly.
• Incision hernia — An incisional hernia occurs at the site of the incision in a prior surgery. Surgery can weaken the abdominal wall, or the incision can become infected, further weakening the area. Incisional hernias are somewhat common, simply because the incision weakens the wall, making it easy for a part of the intestine or some other tissue to push through. These hernias typically occur along vertical incisions, and they will not heal on their own. They can be large and pretty painful.
• Spigelian hernia — Spigelian hernias occur through the spigelian fascia, the layer of tissue that separates two groups of abdominal muscles. Unlike other types of hernias, which develop immediately below layers of fat, spigelian hernias occur in the midst of abdominal muscles. Because of this, they may not be visible through a bump or bulge, making them undetectable for longer periods of time. This is dangerous, as these hernias tend to be small, and they have a higher risk of strangulation.
• Umbilical hernia — Umbilical hernias occur when a weak spot in the belly allows a bit of intestine, fat, or fluid to push through, creating a bulge or lump near the belly button. These hernias are more common in infants, and these usually heal on their own. In adults, umbilical hernias are caused by health issues that cause increased pressure in the belly. These issues include chronic coughing, obesity, pregnancy, constipation, and difficulty urinating. In adults, umbilical hernias tend to grow bigger over time and will typically require surgery to address. Leaving them alone invites potential strangulation.
• Inguinal hernias — Inguinal hernias appear in the crease of the groin or in the scrotum. They are more common in men. These usually result from weak spots in the abdominal wall that can be present from birth or form later in life. They will cause bulges along the pubic or groin area that can increase in size when you stand up or cough. These can involve sharp pain and burning sensations. The same pressure discussed above, from chronic coughing, constipation, or obesity, is usually behind most inguinal hernias.

In most cases, these hernias can be diagnosed through visual examination and by gently palpating the affected area.

If there is still some question about whether or not a hernia exists, we may order an imaging test, such as an abdominal ultrasound, CT scan, or MRI. These imaging tests can help show the hole in the muscle wall, along with the tissue protruding from it.

Many abdominal wall hernias where the patient has no associated symptoms can be left alone, adopting a wait and see attitude. But larger hernias, or if the hernia is causing pain, may require surgical repair to address the problem. This can also be necessary to prevent possible complications.

Hernia surgery can be done using open surgery or minimally invasive methods. The type of hernia, its severity, and your past medical history will likely dictate the approach used. Your Northwestern Surgical Associates surgeon will discuss your options, opting for minimally invasive surgery if at all possible.

• Open surgery — An incision is made into the groin to gain access to the abdomen. The protruding tissue is pushed back into the abdomen, and the weakened areas is sewn up to return strength. If necessary, a mesh may be used to reinforce the weakened area. Open hernia surgery can involve a somewhat lengthy recovery before you can return to normal activities.
• Minimally invasive surgery — When using minimally invasive techniques, your Northwestern Surgical Associates surgeon will make a few small incisions in your abdomen. Your abdomen will then be inflated with a special gas to make it easier to see your internal organs. A laparoscope, a small tube with a camera on the end, will then be inserted into one of your incisions. This provides visuals without needing a long incision. Instruments are inserted through the other incisions, and the hernia is repaired. Mesh may be used to strengthen the area. Minimally invasive surgery makes for an easier, faster recovery, and quicker return to normal activities.

This also varies by repair. A minimally invasive approach may stay in the hospital one night. However, most patients require an open repair and 5-7 days in the hospital while the bowels wake up. Walking is HIGHLY recommended even from the day of surgery. We recommend not lifting greater than 20 pounds for 4 weeks to help prevent the hernia from coming back. Patients in a more frail state before the operation sometimes need to recover for some time at acute inpatient rehab elsewhere or a nursing facility before returning home.

Some abdominal wall hernias don’t require treatment, but all hernias merit at least monitoring. If you suspect you have a hernia, it’s a good idea to see your doctor and have it checked out. From there, he or she may simply want to keep an eye on it, or they may send you to us at Northwestern Surgical Associates for surgery.

The danger of not at least monitoring a hernia is that it can become a strangulated hernia, and strangulated hernias can be life threatening.