Hernias

ABDOMINAL WALL HERNIAS

A hernia is the protrusion of tissues and organs from inside the abdomen through a weak area in the abdominal wall, out of the abdominal cavity, forming a swelling under the skin. Hernias can be classified as inguinal (groin) hernias, umbilical (navel) hernias and incisional hernias.
Abdominal wall hernias may be congenital, or they may appear later in life. They can be seen at any age, from newborns to the elderly. Inguinal hernias, which make up 90 percent of all hernias, are more common in men, while umbilical hernias are more common in women.

What causes a hernia?
- constantly lifting heavy loads
- chronic cough
- straining during bowel movements because of chronic constipation
- straining to urinate because of prostate enlargement (hypertrophy) are the most common causes. In addition,
- repeated pregnancies
- cirrhosis accompanied by fluid in the abdomen (ascites)
- rapid weight loss
- incisions made for abdominal operations are also factors that make a hernia more likely to form.

Symptoms of a hernia
Patients usually seek help because of a swelling, and sometimes pain, that becomes more noticeable when standing up, coughing or straining and disappears when lying on the back. Once a hernia has been diagnosed, it should be treated surgically as soon as possible.
The most important reason for hernia surgery is to prevent serious complications such as bowel strangulation and bowel obstruction. If the defect that causes the hernia is not repaired surgically, the bowel that enters it may become trapped inside the hernial sac, and over time its blood supply may be impaired, leading to gangrene or bowel obstruction, problems that can require emergency surgery.
 

INGUINAL HERNIA

Inguinal (groin) hernia is the most common abdominal wall hernia and is much more frequent in men. There are 3 types of inguinal hernia:

1- Indirect inguinal hernia
In this type of hernia, the peritoneal sac that should normally have closed at birth and turned into a fibrous band has remained open. At some point in life, when intra-abdominal pressure rises because of coughing, straining or lifting heavy loads, the abdominal organs tend to enter this peritoneal sac and the inguinal canal.

2- Direct inguinal hernia
In this type of hernia, the supporting tissue in the groin region is weak, and in adults the abdominal organs herniate through this area.

3- Femoral hernia
These are hernias that arise from the femoral canal, through which the vessels and nerves supplying the leg pass. They are more common in women. They mostly present with a swelling seen below the groin region and pain radiating to the leg. Clinical signs and symptoms
Most inguinal hernias may cause no symptoms until a swelling in the groin, the typical sign of a hernia, appears; sometimes there may be only pain. Particularly with
- standing,
- walking,
- straining,
- coughing, and lifting heavy loads,
pain and swelling occur in the groin, and the pain may radiate toward the scrotum. The swelling and pain are seen to disappear on lying on the back.
In hernias left untreated for a long time, the bowel may become trapped in the hernial sac and cause bowel obstruction. In this case, besides a painful, sometimes reddened, hard swelling in the groin that does not go back in, difficulty passing gas and stool may be observed.

Diagnosis of a hernia
When the swelling is obvious, the diagnosis can be made with a simple examination. In patients who report only pain without any swelling in the groin, the groin region can sometimes be examined with ultrasonography, and hernias at an early stage (pinpoint hernias) can be detected.

Treatment of a hernia
Inguinal hernias are repaired with surgical treatment once they are diagnosed. In the repair, the hernial sac and its contents are dealt with first, and then the defect (weak tissue) in the groin wall is repaired. The most important complication arising during hernia repair is recurrence.
Today, to prevent hernia recurrence, the weak tissue is reinforced from the outside with a synthetic mesh. This mesh quickly integrates with the abdominal wall and forms a strong repair tissue in the weak area. After tension-free hernia repair, the recurrence rate is between 0 and 2%.
Laparoscopic repairs, which are used today, are the methods preferred especially for recurrent hernias and bilateral hernias.
 

UMBILICAL HERNIA

While the baby is in the mother's womb, the vessels that form the link with the mother and meet the baby's needs for growth pass through the umbilical ring. At birth these vessels close. An umbilical hernia occurs when abdominal organs pass in and out of this opening because the umbilical ring has not closed completely.

Umbilical hernias in children can be observed until the age of 4, unless there is strangulation of the hernia or bowel obstruction, because they usually close on their own.

An umbilical hernia that develops in adults does not close on its own and must be treated surgically.

The umbilical hernia, which is a congenital hernia and is more common in women, appears as a swelling at the navel, particularly after pregnancy or after chronic cough, constipation or heavy lifting.

Sometimes it can reach the size of an orange. If this swelling, which disappears when lying on the back, suddenly grows, becomes painful and red, or cannot be pushed back into the abdomen, this suggests that abdominal organs are trapped in the hernial sac. In this situation emergency surgery is needed; otherwise the trapped bowel, whose blood supply has been impaired, also has to be removed. This prolongs what is normally a relatively easy hernia operation, after which the patient goes home on the same day or one day later, and it also means a longer hospital stay and additional problems for the patient.
 

INCISIONAL HERNIA

These are hernias that develop at the site of an incision in people who have previously had abdominal surgery.

- the technique of the previous operation
- advanced age
- a wound infection that has developed
- the patient's own conditions that delay tissue healing (diabetes, obesity, anemia, chronic diseases, cancer, etc.) are factors that make incisional hernia formation more likely.

These hernias can appear right after the operation or many years later, and over time they can reach very large sizes. In the surgical treatment, which can be performed by open or keyhole (laparoscopic) methods depending on the size of the hernia and the patient's preference, synthetic meshes that support the almost always weakened abdominal wall without tension are used.