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Hernia Basics

How does a hernia occur?

The abdominal wall (belly muscle) is very important in the normal functioning of the human body. We rely on a strong abdominal wall to do everything from simply bending over to pick up a sock to heavy manual labor. Although we do not think about it, we hold our breath slightly when we open a door, pick up a drink, or go to the bathroom. We sometimes think about it a lot and intentionally hold our breath while we are straining hard to pick up something very heavy or perhaps when we are constipated. When your belly muscles are working well, these activities can be done without thinking about it and without pain.

The abdominal wall muscles form a complete circle around the middle of the body. They start from the back and are attached to the lower ribs on the top and to the pelvic bones on the bottom. The muscles meet together in the middle at the belly button (between the “six pack” muscles). The abdominal wall muscles obviously help us to do things like exercise and work; but they also perform another very important function, they keep our intestines safely inside and protected from the outside world.

Unfortunately, there are some design defects in the abdominal wall system that lead to the most common types of hernias:

What are some common forms of hernias?

Umbilical Hernia (belly button hernia or “outie”)

Everyone is attached to mom at birth by the umbilical cord. After the cord is cut the hole closes shut (scars shut) on its own. Unfortunately, scar tissue is not nearly as strong as normal muscle or the tough tissue that surrounds muscle (fascia) and is prone to weaken over time after repeated episodes of stressing and straining. Both men and women are subject to belly button hernias. Women tend to notice them more during or just after pregnancy because of the tremendous forces and changes that occur during pregnancy.

Inguinal Hernia (groin hernia)

The junction of the lower abdominal wall muscles and the pelvis is thinner than the rest of the belly. This is especially true for men because the testicles start out inside the belly and later descend into the scrotum just before being born. The muscles have to open up to allow the testicles to pass and then close behind once they have completed their descent. Unfortunately, this process is not always perfect and the closure is incomplete. The problem is further worsened because the muscles cannot ever completely close due to the fact the the spermatic cord is in the way. Groin hernias can occur in both women and men but are far more frequent in men due to the issue with testicular descent.

Laparoscopic Hernia Repair

Laparoscopic Hernia Repair is a minimally invasive procedure to fix tears in the abdominal wall (muscle) using small incisions, a camera, and a surgical mesh patch. Your surgeon will determine if you are a candidate for this procedure or will require a more traditional open surgical approach.

Ventral Hernia (Incisional hernia)

Incisional hernias form at the site of a prior surgical cut. They form because all cuts in the body heal with scar tissue which is always much weaker than the tissues we are born with. The most common cut on the abdomen is straight up and down,  in the middle, between the six pack muscles.  Hernias may occur in any surgical wound on the abdominal wall, in fact, it is estimated that as many as 30% of patients who undergo abdominal surgery may evenutally develop an incisional hernia.

Parastomal Hernia ( hernia in association with a colostomy or urostomy)

Parastomal hernias occur around a permanent stoma site in patients that have colostomies, ileostomies or urostomies following intestinal, colon or urologic surgery. Parastomal hernias usually cause the stoma site to bulge and may make it difficult to pouch or place an ostomy appliance. Parastomal hernias are difficult to deal with since the stoma itself represents a weak spot in the abdominal wall that must stay and cannot be completely reinforced with mesh, as is often done in other types of hernia repairs. Parastomal hernias often occur simultaneously with an incisional hernia (through the original surgery site). Both hernias need to be addressed and repaired for longterm satisfactory outcomes. These operations are less common, particularly complex and are best performed by surgeons with substantial interest and experience in this type of repair.

Abdominal Wall Reconstruction (AWR)

Abdominal wall reconstruction is a term sometimes used to describe “hernia repair” or “hernia surgery.” AWR is a way of considering the abdominal wall, and the hernia in it, as a complete system. Rather than just “patching the hole,” AWR considers the way the entire group of muscles in the abdominal wall work together with repairs designed to take advantage of the natural mechanics and physics of the abdominal wall with the goal of restoring normal functionality of the abdominal wall while minimizing the risk of hernia recurrence.