A hernia is a condition in which a portion of the tissue lining the abdominal cavity (peritoneum) breaks through a weakened area of the abdominal wall. Hernias usually occur either because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall, such as the strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. Eighty percent of all hernias are located near the groinSerious complications from a hernia result from the trapping of tissues in the hernia -- a process called incarceration. Trapped tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of incarceration requires surgery.

What Are The Characteristics and Symptoms?

The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in groin region, which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force occurs at the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues enlarging any pre-existing hole, or leading to a tear, resulting in a new hole.

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. When part of the stomach and esophagus protrudes through the diaphragm into the chest cavity, this is known as a hiatal hernia. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). This type of hernia is usually painless. Hernias can also occur within the navel (umbilical hernia).

There are also epigastric, umbilical, incisional, lumbar, internal, and Spigellian hernias; all occur at different sites over the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

Who Is Most Likely To Have This Condition?

Risk factors for hernia include:

Family history. Your risk of inguinal hernia increases if you have a close relative, such as a parent or sibling, with the condition.

Smoking. A chronic cough from smoking increases your risk of hernia.

Chronic constipation. This leads to straining during bowel movements - a common cause of inguinal hernias.

Excess weight. Being moderately to severely overweight can put extra pressure on your abdomen.

Pregnancy. This can both weaken the abdominal muscles and cause increased pressure inside your abdomen.

Standing for long periods or heavy lifting.

Premature birth. Infants who are born sooner than normal are more likely to have hernias.

History of hernias. If you've had one inguinal hernia, it's much more likely that you'll eventually develop another — usually on the opposite side.

What Does Surgery Involve?

Hernia Surgery:

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the problems with this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. This has proved to be a very effective means of repair.

After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures.

Laparoscopic Hernia Surgery:

This technique is really an extension of a traditional mesh repair method (preperitoneal repair) that was usually used in patients who had already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The apparent advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of post-surgical pain.

The potential disadvantages of the technique are: (1) a general anesthetic is required; (2) the risk of injury to blood vessels in the abdomen is increased; and (3) the long-term effects of placement of the mesh in this location remain unknown.

What Are The Advantages Of Surgery?

It resolves a structural problem that can worsen if left untreated.

How Long Does It Take?

Most hernia surgeries usually take about a half hour.

How Many Treatments Are Required?

One.

What Are My Alternatives?

• None proven effective. Hernia repair requires surgery.

Will I Have Pain?

There is typically some postoperative pain with hernia surgery - - walking will be uncomfortable. Pain medication will typically be required for 3-5 days.

When Can I Go Back To Work Or School?

We recommend two to three weeks of recovery before resuming normal work activity. Depending on the type of hernia and the specific procedure, recovery times may vary.

Who Will Perform My Treatment?

The surgery will be performed by one of our highly-trained specialists in the field.

How Much Does It Cost?

Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Most insurance companies will cover these procedures.