Hernia Information

What is a Hernia?

A hernia is the protrusion of an organ or tissue through the wall of the cavity that normally contains it. The most common site is the abdomen and these hernias may be inguinal or groin hernias, ventral or incisional hernias, umbilical or bellybutton hernias, or sports hernias.

Hernias often present as a bulge containing either intestines or fatty tissue. Sometimes the only indication of a hernia is pain which is often exacerbated by activity particularly exercise, coughing or sneezing. The symptoms may be even more vague and only appear when sitting or prolonged standing. The diagnosis requires not only the history but also a physical examination. It may require a CT scan as well.

Hernias do not get better on their own. They typically become larger and may become more symptomatic with time. There is a risk that strangulation of the protruding organ or tissue may occur resulting in the need for an emergency surgery with significantly higher complication rates. This can be avoided with elective operation.

The safest, most painless and most successful hernia repair is done with a tension-free mesh repair. Options for laparoscopic or open repair exist for most types of hernias. Matching the appropriate operation to the appropriate patient is the key to successful surgery. Most of these procedures are performed on an outpatient surgery basis and return to non-strenuous activity is quick.

Types of Hernias

Inguinal or Groin Hernias

Inguinal or groin hernias are the most common type of hernia. They are more common in men than in women. They can be either indirect or direct. An indirect inguinal hernia forms in the opening of the inguinal canal. The intestines or fatty tissue may protrude through this opening forming a bulge in the groin. In a direct hernia there is weakness of the back wall of the inguinal canal resulting in a bulge. Some hernias are a combination of both of these. A tension-free mesh is used for repair of virtually all inguinal hernias.

Femoral Hernias

Femoral hernias are another type of groin hernia. They are more commonly found in women and present as a bulge just below the crease where the leg meets the abdomen (below the inguinal ligament). Incarceration when the mass won't go back in, or strangulation when the blood supply to the mass is being squeezed or compromised is more common with this type of hernia. A tension-free mesh repair is usually performed.

Umbilical Hernias

Umbilical hernias bulge through the bellybutton. In babies, these can be observed because many of them will close spontaneously. They often occur in adults due to pregnancy or obesity but may occur in anyone. Small umbilical hernias in thin patient's may be repaired without mesh. Larger hernias, or in heavy patients, may require a mesh repair.

Incisional Hernias

Incisional hernias occur through the scar from a prior surgery. These can occur months or even years following a prior operation. They become more difficult to repair if they are left untreated. The weakened tissue continues to thin and stretches, making repair more complicated and the risk of recurrence higher. A mesh repair is almost always indicated for this type of hernia. These may become very complicated if they recur and require a more elaborate operation such as a component separation procedure. This option is available through our Hernia Center.

Ventral Hernias or Epigastric Hernias

Ventral hernias or epigastric hernias appear in the midline of the abdomen and are often due to weakened or stretched tissue. Considerations for repair are the same as with incisional hernias.

Sports hernias

Sports hernias are different than other hernias in that there is often no hole or defect. These are due to tears in the muscle or fascia. Diagnosis is often difficult and may require additional imaging particularly with MRI. Even then, the diagnosis may only be made by history. The best treatment is rest, analgesics and possibly physical therapy. Surgery is the last resort for this type of hernia.