Abdominal Wall Hernia

What is an Abdominal Wall Hernia?
An Abdominal wall hernia is a protrusion of organs through the wall of the abdomen which was naturally designed to enclose such organs. The abdominal wall has large muscles that contains and maintains the intra-abdominal organs in place. However there are times when weakness of such muscles develops or if the patient had previous abdominal surgery or for congenital reasons, the intra-abdominal organs protrude outwardly and a bulge may then be felt and seen.

What are the signs and symptoms?
Based on TMC’ historical data on abdominal wall hernia, from 2002 to 2006, there has been a 30% increase of the aid procedure done at the hospital. Patients with abdominal wall hernias complain of a bulging mass usually when they strain or cough especially when in an upright position. The most common location of this bulging mass is in the groin area. These are known as inguinal hernias.

Bulging in an area of a previous surgical incision like after a hysterectomy is known as an incisional hernia.  Any previous abdominal surgical operation no matter how small, is potentially at risk for incisional hernia especially if there was a previous wound infection. Umbilical hernias are protrusions of the umbilical area in children. These are congenital but may also manifest later in life.

Another type of hernia known as a ventral hernia, is a bulge usually right in the middle of the abdomen with no previous surgery.

All types of hernias present with a bulge which may or may not be associated with pain, especially with prolonged standing or walking. Most hernias disappear or are “reducible” when these patients lie down or push the bulge inwardly.

Risk Factors:
-   children born prematurely
-   adult with chronic cough, chronic constipation
-   heavy smokers
-   certain abdominal operations with development of post-
operative infections

How are Hernias Diagnosed?
Since hernias simply present as a bulge with or without associated symptoms, the finding of a mass especially with a history of reducibility already confirms the diagnosis.  In other words, the diagnosis is made on clinical grounds with no need for any special test like an ultrasound, CT scan, blood exams, etc. Any individual who presents with such should see a physician, preferably a surgeon. 

What is the treatment for hernias?
Abdominal wall hernias are always treated surgically. The only type of hernia that may be expected to disappear without surgery are umbilical hernias seen in babies. All other hernias can only be treated through an operation called a herniorrhaphy. In adults, the approach to this procedure can be done either through the traditional approach or via the laparoscopic option.

What are the complications of abdominal walls hernia?
As mentioned earlier, most hernias disappear or are “reducible” when these patients lie down or push the bulge inwardly. Hernias that were previously reducible but suddenly can't be reduced are known as incarcerated hernias. These may rapidly progress and cause increasing pain and discomfort and should be treated immediately. An incarcerated hernia, if left untreated, may become “strangulated” which means the blood supply to the organ that herniated may be cut-off and cause gangrene of the herniating organ. This condition requires emergency intervention.

How can The Medical City help you?
At The Medical City, general and pediatric surgeons are available to help one in making the diagnosis and treatment of abdominal wall hernias.  There surgeons can explain the condition and the treatment options. Hernia surgery is a very safe procedure and is one of the most frequently performed surgeries in the country. After such operations, most patients may be expected to be up and about immediately after the surgery and can be discharged soon after. Note: This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment.

References :
Laparoscopic Hernia Repair-Patient Information   Brochure from SAGES Task Force on Patient
Information,  March 2004
Surgery: Basic Science & Clinical Evidence , Norton JA et al, Springer-Verlag 2001

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For any inquiries or if you would want to seek consult, please call:

DEPARTMENT OF SURGERY
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6288

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444