What is a hernia?
A hernia is a hole through the abdominal muscle wall where the organ beneath it can protrude through that hole. One’s lifetime risk for developing a hernia can range from 5-27 percent. Hernias can be asymptomatic, present as a bulge, be uncomfortable, cause debilitating pain, or can present as an emergency problem with incarceration causing obstruction or strangulation of the intestine.
Types of Hernia
Abdominal wall hernias: Occur through the muscles of the abdominal wall, back or perineum and are almost always repaired with implantation of mesh to minimize the chance of recurrence. Learn more about Abdominal Wall Hernias.
Inguinal: The most common type of groin hernia. An indirect inguinal hernia results from a defect present since birth that may reveal itself anytime during one’s life. A direct inguinal hernia is acquired and typically develops following years of strenuous activity. A small unilateral inguinal hernia can be repaired using a conventional open or laparoscopic repair with mesh. A recurrent inguinal hernia or bilateral inguinal hernias are usually repaired using a minimally invasive approach with a laparoscope to allow patients less pain and a faster return to full activities. Learn more about Inguinal Hernias.
Femoral: The least common but most dangerous type of groin hernia. This hernia forms alongside the femoral blood vessels exiting the pelvis into the upper thigh. This hernia can be repaired using a minimally invasive laparoscopic or open infra-inguinal approach.
Umbilical: A common hernia with a defect at the ‘belly-button” present since birth that may reveal itself anytime during one’s life. This hernia can be repaired using a laparoscopic or open approach. On occasion this hernia can be repaired simultaneously with an inguinal hernia repair or an abdominoplasty otherwise known as a “tummy-tuck.” Learn more about Umbilical Hernias.
Epigastric: This hernia develops through the midline of the abdominal wall between the umbilicus and xyphoid process of the sternum. This hernia can be repaired using an open or laparoscopic approach with or without mesh depending on the size of the defect.
Incisional: This hernia develops through the site of a previous surgical incision. Approximately 7-13 percent of all abdominal surgeries will result in the formation of an incisional hernia. This type of hernia can be routine or complex and can be repaired using minimally invasive laparoscopic techniques, open techniques, and sometimes a combination of both. Complex incisional hernias are usually multiply-recurrent, may have open draining wounds, infected and contaminated mesh, may have associated intestinal fistulas, may be extremely large with “loss of domain,” may be associated with significant patient comorbidities and can typically be very complicated and challenging to repair. Classic repairs of these types of hernias typically are at high risk for recurrence and wound complications. Therefore these repairs require knowledge of and experience with a variety of different techniques and mesh materials in order to maximize surgical results. Our surgeons are national experts in performing the surgery using state-of-the-art techniques and a variety of mesh materials for reinforcement to optimize each patient’s outcome and to minimize the risk of complications and recurrence. Our surgeons have participated in many training courses throughout the United States and Europe teaching surgeons these advanced techniques. Learn more about Incisional Hernias.
TRAM donor site: Up to 5% of patients undergoing TRAM flap reconstruction following surgery for breast cancer will develop TRAM donor site abdominal wall hernia defects. Our surgeons are experts in managing this specific type of hernia. We have published and presented at national meetings our technique developed to specifically address this type of hernia both to repair the defect and provide a cosmetically pleasing result for the patient.
Parastomal: A hernia that occurs alongside a stoma through the abdominal wall. This can occur in as many as 30-50 percent of all stomas. An ileostomy, colostomy, or ileal conduit are the most frequent types of stomas. Patients with temporary stomas can have the hernia repaired at the time of the stoma reversal operation. Those with permanent stomas usually need to have these hernias repaired since it can be symptomatic and often interfere with a securely fitting stoma appliance. Since the risk of forming a parastomal hernia is so high a prophylactic mesh can be placed around the stoma during its creation to prevent the future development of a parastomal hernia.
Spigelian: A hernia of the lower lateral abdominal wall that occurs at the junction of the vertical Linea Semilunaris and the horizontal Arcuate Line of Douglas. This can be repaired with a laparoscopic or open approach with mesh.
Perineal: A hernia through the muscles of the pelvic floor.
Lumbar: A hernia of the flank or back that often involves the iliac crest bone as one of the borders of the hernia defect. This hernia often requires the use of advanced techniques to minimize recurrence. Bone anchors are commonly placed into the iliac crest to anchor the mesh at that location to allow strong mesh fixation to avoid recurrences.
Sportsman’s: Prevalent in athletes, Sportsman’s hernia is associated with significant pain in the inguinal region that follows overuse of the lower abdominal and upper thigh muscles. This is a controversial hernia since in most cases a true hernia defect does not exist. Most of these cases of pain are believed to most likely result from a chronic groin strain or injury. A Sport’s Medicine Orthopedic Surgeon may also be involved in the evaluation of this problem. Treatment involves a trial of restricted activity, physical therapy and anti-inflammatory medications to eradicate the pain. If a long trial of treatment is not successful then surgery may be considered.
Diaphragmatic hernias: Occur through the diaphragm muscle separating the chest cavity from the abdominal cavity.
Hiatal: A hernia that occurs through the esophageal hiatus of the diaphragm. Organs from the abdomen enter through the hiatus into the chest cavity. There are four types of hiatal hernia: (1) Sliding, (2) Paraesophageal, (3) Combined sliding and paraesophageal, and (4) a hiatal hernia that involves the stomach and other organs of the abdominal cavity that has herniated into the thoracic cavity.
Hiatal hernia types 2-4 usually require repair since they can be very symptomatic. Some of the symptoms include difficulty swallowing food (dysphagia), substernal chest pain, weight loss, nausea, vomiting, early satiety, exacerbation of asthma, and aspiration pneumonia. Anemia from ulcer formation can occur and result in acute or chronic blood loss. One can present emergently with bleeding, incarceration, strangulation, and/or volvulus of the stomach within the chest. The majority of these hernias are repaired using a laparoscopic or robotic transabdominal approach. Learn more about Hiatal Hernias.
Congenital diaphragmatic hernias: Morgagni or Bochdalek: Failure of diaphragm fibers to fuse together during fetal development resulting in a hole in the diaphragm. Organs from the abdominal cavity can pass through the hole in the diaphragm and enter the chest cavity. These hernias are often repaired using a laparoscopic approach.