Hernias: causes, symptoms and treatment
A hernia is a protrusion of part of an organ through the muscle or tissue that contains it. It can occur in the groin, brain and spine but most commonly occurs in the abdomen.
Abdominal hernias
The layers of the abdominal wall are, from outside to inside, the following:
• Skin
• The subcutaneous tissue or subcutaneous fat
• Aponeurosis (a kind of tendon)
• Muscular layer (layer 1)
• Aponeurosis (layer 2)
• Properitoneal fat and peritoneum (a membrane that covers most of the organs in the abdomen).
In certain areas of the body, layers 1 and 2 can vary or be absent, having only one of the two aponeurosis layers, for example just in the midline of the anterior abdominal wall or linea alba (muscle running up the middle of the inside of the abdomen).
A defect on the muscular-aponeurosis layers can produce a protruding pouch of peritoneum, or hernial sac, which comes through the hernial orifice (the muscular-aponeurosis defect), producing a hernia visible from the outside.
What causes hernias?
A hernia, also called ventral hernia or incisional hernia, which occurs after a history of penetrating trauma to the abdominal wall, or in surgery. The incidence of occurrence of incisional hernias varies between 1 - 16%, although this percentage may be higher depending on the type of surgery. The appearance of hernias is also associated with other risk factors such as obesity, contaminated surgical procedures, diabetes, a weak or suppressed immune system, or other underlying diseases.
Hernia symptoms
The symptoms that the patient experiences include the presence of a tumour or deformity of the abdominal wall at the scar site or close to it, which is often accompanied by pain or discomfort in varying degrees. Sometimes, depending on the patient’s body type and the hernia itself, pain can be the only symptom. Sometimes, a part of the bowel can attach to the hernial sac and cause intestinal transit disorders, or intestinal obstruction (digestion problems). Hernias can potentially become trapped in the abdominal wall and even strangulated. Trapped or strangulated hernias usually cause severe and constant pain and swelling in the area of the hernia, and could turn into abdominal pain and even cause fever, and they are considered a medical emergency. When the hernia is strangulated, the tissue that is trapped in the abdominal wall stops receiving its blood supply, causing ischemia (a shortage of oxygen and glucose) to that tissue or organ. If the hernia occurs in the intestine or colon and ischemia is sustained over time, it can cause perforation of the intestine.
Hernia treatment
When one of these complications appears, the hernia must be treated urgently with surgery, even though surgery is always the patient’s choice. The treatment of the hernia can be done through open surgery or laparoscopic (minimally invasive) surgery. In both cases, the hernia surgery involves the anatomical correction of the defect and the reinforcement of the abdominal wall by the insertion of a mesh. Nowadays, there are many types and brands of mesh or prosthesis for the repair of the wall on the market, and the surgeon's choice depends on the type of hernia, the conditions of the repair (presence of infection, mesh position according to the specific abdominal area), the type of surgery (open or laparoscopic) and the surgeon’s experience.