Understanding A Hernia
I often explain to patients in the clinic that don't really understand what a hernia represents to just imagine a steak. And if you're vegetarian, bear with me, you know that a good steak can be eaten with a fork, not even needing the steak knife. That's because the muscle splits apart easily. But if you have ever eaten a steak, and you have chewed the gristle in the steak then you understand what fascia is. The fascia, the gristle, is the wrapper around the muscle that keeps the muscle together as it contracts and relaxes. When the fascia develops a hole in it, the muscle thins at that area and whatever is pushing from the inside to the outside on the muscle bulges through. This could be bowel within the hernia sac or it could be intra abdominal fat, or even other organs.
Where Do Hernias Occur?
There are many areas of the body where a hernia can develop. What we most often see and Repair are hernias located in the diaphragm, which can be a hiatal hernia or a hernia on the left or right side of the diaphragm, an abdominal wall hernia which could be as simple as a small umbilical hernia, or a ventral or an incisional hernia located away from the umbilicus but at the site of an old surgical incision or perhaps originating from a weak site of the fascia. The weakest site of the fascia is located within the groin. Herniation at this site leads to what is called an inguinal hernia. This area is a weak spot for both genders, but due to anatomic differences, men develop inguinal hernias more commonly than women. I am often asked about any concerns with herniorrhaphy mesh. Many people have a negative view of herniorrhaphy mesh as they have heard numerous commercials from a recent lawsuit regarding the use of a mesh utilized for vaginal repairs. Obviously, we do not perform vaginal repairs in our practice and leave that to the gynecologists. But, mesh is just a tool we have at our disposal. Without it, we would be unable to repair some hernias and it improves lives. Like most tools, there is the right tool and the wrong tool for a particular type of hernia or patient. You need an experienced surgeon who understands anatomy, the types of mesh products available on the market for any particular hernia, and how those products behave in certain patients. Mesh is a foreign body, just like an artificial hip or knee joint, or a pacemaker, it may get infected or have other complications. The goal of any hernia operation should not be just to fix the hole that is the hernia, but to return the patient back to full form and function without residual pain or loss of motion.
The type of hernia you have depends on its location. The most common types of hernias form in the groin. Other types form in the abdomen. Other common hernias form around the navel (umbilical hernias). They may also occur at the site of a previous surgery. Hernias often recur in the same location (recurrent hernias). In some cases, patients may have multiple types of hernias.
Layers of the Abdominal Wall
The abdominal wall is made up of layers of muscle, fat, and other tissues. Together, they strengthen the abdominal wall. Hernia surgery repairs a weakness in the muscle and connective tissue. This prevents the intestines or other tissue from bulging out again.
Locating Your Hernia
- Epigastric hernias occur in the upper abdomen at the midline.
- Incisional hernias occur at the site of a previous surgical incision.
- Umbilical hernias occur at the navel.
- Direct inguinal hernias occur in the groin near the opening of the inguinal canal
- Indirect inguinal hernias occur in the groin at the opening of the inguinal canal.
- Femoral hernias occur in the femoral canal.