What Is a Hernia?
A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common type of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).
What Causes Hernias?
Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.
Anything that causes an increase in pressure in the abdomen can cause a hernia, including:
- Lifting heavy objects without stabilizing the abdominal muscles
- Diarrhoia and constipation
- Persistent coughing and sneezing.
In addition, obesity, poor nutrition and smoking , can all weaken muscles and make hernias more likely.
Classification according to anatomical location
Most hernias occur in the abdomen when a weakness in the abdominal wall leads to a hole forming. Some examples of the most common hernias to occur in the abdomen are given below.
Inguinal hernias occur when bowel tissue or fatty tissue protrudes into the groin area at the top of the thigh. These hernias make up 75% of all abdominal hernias and mainly affect men.
These also occur when abdominal contents protrude through to the groin area. However, these hernias tend to be more rounded than inguinal hernia and mainly occur in women rather than men.
Here, intra-abdominal tissue pokes through the abdomen, near the naval area. These hernias are more common among pregnant women and obese people and post surgical procedure ( open surgery ).
A hiatus hernia occurs when part of the stomach or intestine protrudes into the chest area through a hole in the diaphragm.
Less common hernias
Less common hernias that are also classified according to their location in the body include:
- Epigastric hernia: Fatty tissue protrudes through the abdomen in the area between the belly button and the breast bone.
- Spigelian hernia: A bowel part protrudes through the abdomen, below the belly button and at the side of the abdominal muscle.
- Muscle hernia: A piece of muscle pokes through the abdomen.
- Incisional hernia: These occur when a piece of tissue protrudes through a surgical wound that has not healed properly
LAPAROSCOPIC HERNIA SURGERY
Laparoscopic hernia repair originated in the early 1990s as laparoscopy gained a foothold in general surgery. Inguinal hernias account for 75% of all abdominal wall hernias, and with a lifetime risk of 27% in men and 3% in women. Repair of these hernias is one of the most commonly performed surgical procedures in the world. Even after having surgery, hernia may come back, but this risk is reduced to 50% if the mesh is used during surgery.
A number of studies have shown laparoscopic repair of inguinal hernias to have advantages over conventional repair, including the following
- Reduced postoperative pain
- Diminished requirement for narcotics
- Earlier return to work.
The term laparoscopic inguinal herniorrhaphy can refer to any of the following 3 techniques:
- Totally extraperitoneal (TEP) repair
- Transabdominal preperitoneal (TAPP) repair
- Intraperitoneal onlay mesh (IPOM) repair
The surgeon in a small percentage of patients undergoing laparoscopic hernia repair takes a decision to convert it to an open surgical method considering patient safety, which could be due to non or improper visualization of the organs or due to bleeding which cannot be controlled. This is perfectly normal and should not be considered as a complication or a failure.