What is a Hernia?
A hernia means that the abdominal contents have abnormally pushed their way through the wall of the peritoneal cavity. The abdomen is lined internally with a thin, shiny sheet of material called the peritoneum. It is sterile and totally germ-free. But often, as the organs of the abdomen constantly press against it, if any weakness occurs in the wall of the cavity, they will tend to protrude.
In this way a hernia is born. Frequently they are the result of trauma, such as taking a sudden strain, or lifting an object that is too heavy. Some hernias are congenital in origin, and occur through cavities in the abdominal wall present from birth.
Generally speaking, hernias should be repaired surgically, for there is an inherent risk that a knuckle of bowel may become caught in the opening and become incarcerated. This means that instead of being able to slide freely in and out of the aperture, it suddenly becomes stuck.
Swelling usually follows and, as this proceeds, the blood supply may be cut off. It is possible for death of portion of the bowel to occur, obstruction to take place and a surgical emergency to arise. Unless treated promptly, catastrophic consequences may follow.
The most common hernias are called external abdominal hernias. These may occur in the groin (inguinal and femoral hernias) or around the umbilicus (navel). After surgical operations, sometimes the scar tissue breaks down (years later) and a surgical or incisional hernia results. In practice, in adults, inguinal hernias arc the most common type seen. Often they occur on one or both sides, frequently following some injury, often a simple one. Carrying heavy weights, “letting go” something heavy suddenly, may produce a sudden bulge in the groin. This may occur at once or later on. It may remain a constant size, or it may enlarge over a period of weeks or months.
Treatment is by surgical repair. These hernias will never repair themselves by natural means. The operation is quite straightforward and the aperture is oversewn, with a variety of different techniques being available. The protruding bowel is replaced in the abdominal cavity, and recurrences are usually rare if the patient exhibits commonsense in all activities afterwards.
Umbilical hernias occur in babies and infants, and usually indicate a failure of the aperture through which the umbilical vessels passed before birth to close up adequately at birth, or soon after. The majority of hernias slowly reduce in size, and only a minority require surgical repair. It is unusual for the bowel to become involved, and serious results seldom take place. Femoral hernias occur more commonly in women, usually over middle age and often in the obese. Diagnosis is often overlooked, and strangulation may take place. Surgical repair is the best treatment. Incisional hernias may be large or small. Sometimes they follow major abdominal surgery, particularly in the obese. The resulting herniation may be enormous. Surgical repair offers the only cure.