Types of Hernias
The most common type of hernia to develop in adults. They occur in a part of the abdominal wall known as the inguinal canal, and are much more common in men. Men develop Inguinal Hernias and women tend to develop Femoral Hernias. Men develop hernias 10:1 to women. A man’s testicles must descend through this area before birth. This leaves a natural defect called the internal inguinal ring that can develop into a hernia if it doesn’t seal properly. As a result, the contents of the abdomen, such as intestine, intestinal fat, or bladder may protrude through the opening creating pain and/or a bulge. Inguinal hernias are located in the lower abdomen just above the leg crease, near or adjacent to the pubic area. It is also known that if a person has an inguinal hernia, 30% of these patients will have a hernia on the opposite side and 30% will have Umbilical hernias.
A study revealed that 89% of all men that live to be 90 years old will have hernias.
There are two basic ways to repair inguinal (groin) hernias. One is the open technique in which a 3-4 inch incision is made over the groin. The other technique is with a “Minimally Invasive” technique in which small incisions (1/4 inch) are made in the abdominal wall and a Laparoscope (small camera) is inserted.
Recent studies have shown that both operations are good, safe and reliable operations. Both have low chances that the hernia will recur.
The main difference between an Open operation and a Laparoscopic operation is that the Open operation is more painful and is associated with a longer return to work or full activity.
Personal story: Thirty years ago, I developed a left inguinal hernia. I lived with it for 6 months and it had started to grow. One day, while I was about start a long operation, the hernia started to bulge and ache. I pulled back from the operating table, pushed in back it in place and returned back to the operating table. At that point, the assisting surgeon who was watching me said “Jim, it’s time to get it fixed”!
I underwent an open operation (because the Minimally Invasive procedures had not been invented). The recovery was slow and painful, but I had to make rounds on my hospital patients the next day. It took a full month before I no longer felt any discomfort. I have since returned to full activity, have no pain and exercise daily without restrictions.
Abdominal, Umbilical, Epigastric, Incisional, Recurrent, Ventral, and Diastasis Recti Hernias
These hernias can appear at the site of a previous surgery weeks, months, or even years later, and can vary in size from small to very large and complex. Studies have shown that 30% of all abdominal incisions later develop hernias. A recurrent hernia may develop after an initial repair with using a Tension technique in which a mesh is sewn directly into the hernia hole under tension. If you think you have an incisional hernia, it’s important to see your doctor. Unattended, they may widen and become extremely difficult to repair. Also called ventral hernia. All types of hernias develop a lower chance of recurrence when done with a Non-Tension Technique.
This type of hernias develop anywhere above the midline Umbilicus. They may be small or large. Fat behind the Rectus Muscles called “Preperitoneal fat” may enter the hernia hole. As the hole enlarges, fat from the intestines or intestines may enter. Patients may also develop abdominal bloating after eating. In severe cases, the skin over the hernia may become red and tender. This means that the underlying fat or intestines are being strangled and should immediately be treated or severe complications may develop.
This type of hernias can develop and any time during your lifetime. Women usually develop Umbilical hernias during pregnancy. Men develop them during infancy or adulthood. A bulging mass in the Umbilicus may developed while lifting, coughing or straining. A small hole develops between the Rectus Muscle. Usually abdominal fat behind the muscle protrudes into the hole. Later, fat from the Intestines can protrude through the hole. With time, simple coughing can push more fat through the hole and it stretches. With the hernia defect widening, Intestines can enter the hole. Pain may develop from the hernia which can feel like “pinching, burning, and tearing”. Patients may also develop abdominal bloating after eating. In severe cases, the skin over the hernia may become red and tender. This means that the underlying fat or intestines are being strangled and should immediately be treated or severe complications may develop.
are holes that develops after any abdominal operation. These hernias can appear at the site of a previous surgery weeks, months, or even years later. They can vary in size from small to very large and complex. One incisional hernia may develop or many (Swiss cheese) hernia holes may develop. Studies have shown that 36% of all abdominal incisions later develop hernias. Examples of these are patients who have undergone Gallbladder, Colon, small Bowel, Weight loss, Stomach,
Appendectomies, Prostatic, Vascular, Spleen, Hysterectomies, Ovarian, Bladder and Trauma operations.
are hernias that develop after a prior repair. If the repair was with simple stitches, the stitches may have torn through. If meshes were used, the may have torn away or may have shrunken. All meshes shrink at least 30% and this is why meshes have to be wider than the initial hole in the muscular wall.
Diastasis Recti Hernias
often called a “False Hernia”, is a widening of the space in the abdominal midline which connects the Right Rectus Muscle to the Left Rectus Muscle. The midline is call “Linea Alba”. It may stretch due to obesity, pregnancy or congenital. Signs of this are a bulging mass in the midline abdominal wall above the Umbilicus when the patients sits up from bed. The bulging mass may be small or large. The bulging mass may be from 1 inch to 6 inches wide and may be associated with pain.
Much more common in women, but can occur in men. These hernias appear just below your groin crease and are usually the result of pregnancy and childbirth. A weakness in the lower groin allows an intestinal sac to drop into the femoral canal, a space near the femoral vein that carries blood from your leg. These hernias are more prone to develop incarceration or strangulation as an early complication than are inguinal hernias. Therefore, early repair once these hernias are diagnosed is very strongly advised before such complications occur. All types of hernias develop a lower chance of recurrence when done with a Non-Tension Technique.