Hernias are a common health issue, and understanding what they are is the first step toward managing them effectively. This article will explore “what’s a hernia” in detail, covering the different types, their causes, and the available treatment options, including the use of surgical mesh.
What is a Hernia?
A hernia occurs when an internal organ or tissue protrudes through a weak area in the surrounding muscle or connective tissue. Imagine it like an inner tube pushing through a weak spot in a tire. This protrusion can happen in various parts of the body, but it’s most frequently observed in the abdominal wall. Often, a hernia can be visually identified as a bulge under the skin, particularly when you strain, cough, or bear down. This bulge may disappear when you lie down.
Types of Hernias
Hernias are classified based on their location. Here are the most common types:
- Inguinal Hernia: This type occurs in the inner groin area. It’s the most common type of hernia, especially in men.
- Femoral Hernia: Located in the upper thigh or outer groin, femoral hernias are more common in women.
- Incisional Hernia: These hernias develop at the site of a previous surgical incision in the abdomen.
- Ventral Hernia: A ventral hernia occurs anywhere on the general abdominal or ventral wall, not necessarily at a previous incision site.
- Umbilical Hernia: As the name suggests, this type appears at the belly button (navel). Umbilical hernias are common in infants but can also occur in adults.
- Hiatal Hernia: This hernia is internal, occurring when a part of the stomach pushes up into the chest cavity through an opening in the diaphragm.
Alt text: Diagram showing the locations of common hernia types including incisional, umbilical, inguinal, femoral, and epigastric hernias on the human abdomen.
Alt text: Umbilical hernia example on a torso showing a noticeable bulge near the belly button, indicating tissue protrusion.
Causes of Hernias
Most hernias develop from a combination of increased pressure within the abdomen and a pre-existing weakness in the muscle or connective tissue. This pressure forces organs or tissues through the weakened area. While some people are born with muscle weakness making them susceptible to hernias from birth, in many cases, the weakness develops over time.
Several factors can contribute to increased abdominal pressure and the development of hernias:
- Obesity or Excess Weight: Increased abdominal weight puts extra strain on the abdominal wall.
- Heavy Lifting: Improper lifting techniques or lifting excessively heavy objects can significantly increase abdominal pressure.
- Straining During Bowel Movements: Chronic constipation and straining during bowel movements can weaken abdominal muscles.
- Persistent Coughing or Sneezing: Chronic coughs, such as those associated with smoking or respiratory conditions, and frequent sneezing can increase abdominal pressure.
- Pregnancy: Pregnancy puts pressure on the abdominal wall and can weaken abdominal muscles.
- Poor Nutrition: Inadequate nutrition can weaken muscles over time.
- Smoking: Smoking weakens tissues and can impair healing, contributing to hernia development and recurrence.
- Overexertion: Strenuous activities that strain the abdominal muscles can lead to hernias.
Treatment Options for Hernias
Hernia repair is a frequently performed surgical procedure. In the United States alone, approximately one million hernia repairs are conducted annually. Treatment approaches vary depending on the type and severity of the hernia, as well as the patient’s overall health.
Non-Surgical Options
In a small percentage of cases, specifically 3% to 5%, hernias may require emergency surgery due to bowel obstruction or strangulation of trapped organs, which are serious complications. However, for the majority of hernias, surgical intervention is not immediately necessary. It’s estimated that 30% to 65% of hernias will eventually require planned, non-emergency surgical repair.
If a hernia is small, not causing symptoms, or if the patient has significant health risks that make surgery risky, a surgeon may recommend watchful waiting. This involves monitoring the hernia to ensure it doesn’t enlarge or cause complications. Abdominal binders or trusses can be used to provide support and minimize symptoms by keeping the hernia compressed, but these are not long-term solutions.
Surgical Options
Surgery is often the most effective treatment for hernias, especially those that are symptomatic or at risk of complications. There are several surgical approaches available:
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Laparoscopic Repair: This minimally invasive technique involves making several small incisions in the abdomen. Specialized surgical tools are inserted through these incisions to repair the hernia. Laparoscopic surgery can be performed with or without surgical mesh reinforcement.
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Robotic Repair: Robotic surgery is similar to laparoscopic surgery, utilizing small incisions. However, the surgeon uses a robotic system to control the surgical instruments. Robotic assistance offers potential benefits such as enhanced dexterity, precision, and visualization for the surgeon, potentially leading to improved outcomes.
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Open Repair: In open repair, the surgeon makes a larger incision directly over the hernia site. The weakened muscle area is then repaired. Open repair can also be performed with or without surgical mesh. When sutures (stitches) are used without mesh in open repair, it’s called primary closure. Primary closure is commonly used for inguinal hernias in infants, small hernias, and in cases of strangulated or infected hernias where mesh might not be suitable.
Alt text: Surgical mesh and instruments: Close-up of surgical mesh being held with scissors in a sterile surgical setting.
Surgical Mesh in Hernia Repair
Surgical mesh is a medical device frequently used in hernia repair to provide extra support to weakened tissues. Most surgical mesh devices are made from synthetic materials or animal tissues.
Types of Surgical Mesh:
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Synthetic Mesh: Synthetic meshes are available in knitted or non-knitted forms and can be made of absorbable, non-absorbable, or a combination of both materials.
- Non-absorbable mesh: Designed to remain in the body permanently, providing long-term reinforcement to the hernia repair. It may degrade slightly over time.
- Absorbable mesh: Absorbed by the body over time and loses strength. It is not intended for long-term support. As the mesh dissolves, new tissue growth is meant to strengthen the repair site.
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Animal-Derived Mesh: These meshes are created from animal tissues, such as pig (porcine) or cow (bovine) tissue, which is processed and disinfected to be safe for implantation. Animal-derived meshes are absorbable.
Benefits of Surgical Mesh in Hernia Repair
Hernias have a significant chance of recurring. Surgical mesh is often used to reinforce the repair and decrease the likelihood of recurrence. In fact, mesh is used in the majority of hernia repair surgeries in the United States. Medical research consistently shows that using mesh reduces the rate of hernia recurrence.
However, there are situations where mesh might not be recommended. Patients should discuss their individual circumstances with their surgeon to determine the best approach for their hernia repair.
Mesh may also contribute to improved patient outcomes by potentially reducing operative time and shortening recovery. However, recovery time varies depending on factors like the type of hernia, surgical technique (open or laparoscopic), and the patient’s health before and after surgery.
Risks of Surgical Mesh in Hernia Repair
While surgical mesh offers benefits, it’s important to be aware of potential risks. Based on analyses of medical device adverse event reports and scientific literature, common complications after hernia repair, whether with or without mesh, include:
- Pain
- Infection
- Hernia Recurrence
- Adhesion (scar-like tissue sticking tissues together)
- Obstruction (blockage of the small or large intestine)
- Bleeding
- Fistula (abnormal connection between organs, vessels, or intestines)
- Seroma (fluid buildup at the surgical site)
- Perforation (hole in neighboring tissues or organs)
In hernia repair specifically using mesh, additional potential adverse events include:
- Mesh Migration: Movement of the mesh from its original position.
- Mesh Shrinkage (Contraction): Mesh decreasing in size after implantation.
These mesh-related complications can contribute to the general complications listed above.
Additional Resources
- K. Malhotra and A. Bawa. Prioritizing and Promoting Hernia Awareness Month: A Call for Action. World J Surgery 2022. doi: 10.1007/s00268-022-06553-6.
- D. Kokotovic, H. Sjølander, et al. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe. Hernia 2016; 20(2):281–7. doi: 10.1007/s10029-016-1464-z.
- L. Funk, K. Perry, et al. Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc. 2013; 27(11):4104-12. doi: 10.1007/s00464-013-3075-4.
- D. Kokotovic, T. Bisgaard and F. Helgstrand. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA 2016; 316 (15):1575-82. doi: 10.1001/jama.2016.15217.
