Abdominal Wall Hernias

What is a hernia?

A hernia is an abnormal protrusion of internal organs or structures (such as bowel or fat) through an abnormal defect or weakness in abdominal wall (the muscular/tendinous layer of the belly).

How do hernias manifest?

Hernias are usually noticed as “lumps” in the belly. These lumps tend to occur in natural areas of weakness, most usually in the belly button (umbilical hernia) or the groin (inguinal or femoral hernias).

These areas are naturally weak as they are areas which allow the passage of structures in and out of the abdomen:

  • Belly button – for the umbilical cord in foetal life
  • Inguinal (groin) – for the passage of the spermatic cord which goes to the testicles
  • Femoral (lower groin) – for the passage of blood and lymph vessels into and out of the legs
  • Epigastric

Other less common hernias include:

  • Incisional (patient with history of past abdominal surgery)
  • Spigelian
  • Parastomal (patient with co-existing stoma)
  • Obturator

 Hernias have several peculiar characteristics:

  • They are often “reducible” – that is, can be pushed back into the belly
  • They may come out when standing/during the day and disappear on lying down (often at night)
  • They protrude more on straining or coughing.

How are hernias diagnosed?

Hernias usually do not require any tests for diagnosis – they can be diagnosed purely on examination by a doctor or surgeon. Occasionally if the diagnosis is in doubt, ultrasound may be used to diagnose them. For complex hernias, a CT scan may be used to assist in the planning of surgery.

What is the treatment for hernias and why should they be treated?

Apart from being often unsightly, hernias carry a risk of “strangulation”. This is where the organ/bowel gets caught in the hernia and could not return into the abdomen. Eventually, the blood supply of the entrapped bowel gets cut off, leading to the death of the caught bowel. This then becomes a surgical emergency as the patient can get really sick in the process.

How are hernias treated?

Hernias are generally treated with surgery. This surgery can be performed both laparoscopically (keyhole surgery) or as an open operation. For details regarding surgery for hernias, please see hernia repair section.