Cough! That is a part of the exam to confirm if patients have certain types of
hernias. Besides pain, the tell-tale bulge is a giveaway that something is going on in
the belly or groin areas. Remember people, LIFT WITH YOUR LEGS!

     A hernia is caused when the muscles of the abdomen develop a weak spot, or
defect, through which abdominal contents can bulge out. The contents of the hernia
are contained within a thin lining called the hernia sac.

Umbilical Hernia
     An umbilical hernia develops when a sac with abdominal contents protrudes through
the umbilicus (belly button).

     Umbilical hernias are relatively common in adults. They are more common in
overweight people and in women, especially after pregnancy. Most surgeons
recommend they be surgically repaired, as they tend to get bigger over time.
Without surgical repair, there is a risk that some abdominal contents, typically a bit
of fat or intestine, will get stuck (incarcerated) in the hernia defect and become
impossible to push back in, which is typically painful. If the blood supply is
compromised (strangulation), the patient requires urgent surgery. Incarcerated
abdominal tissue may cause nausea, vomiting, and abdominal distension.

     Any patient with a hernia that cannot be reduced, or pushed back in, while lying
down and relaxed should seek urgent medical attention.

     Most umbilical hernia repairs are done on an outpatient basis, but some may require
a short hospital stay if the hernia is very large.

Ventral/Incisional Hernias
     A ventral hernia can develop in any area of the abdomen above the groin. When a
ventral hernia occurs, it usually arises in the abdominal wall where a previous
surgical incision was made (Incisional hernia). In this area the abdominal muscles
have weakened; this results in a bulge or a tear. In the same way that an inner
tube pushes through a damaged tire, the inner lining of the abdomen pushes
through the weakened area of the abdominal wall to form a balloon-like sac. This
can allow a loop of intestines or other abdominal contents to push into the sac. If
the abdominal contents get stuck within the sac, they can become trapped or
“incarcerated.” This could lead to potentially serious problems that might require
emergency surgery.

     Traditional hernia repair is done through an incision in the abdominal wall. The
surgeon may choose to sew your natural tissue back together, but frequently, it
requires the placement of mesh (screen) in or on the abdominal wall for a sound
closure.

     Laparoscopic hernia repair is a technique to fix tears or openings in the abdominal
wall using small incisions, laparoscopes (small telescopes inserted into the
abdomen) and a patch (screen or mesh) to reinforce the abdominal wall. It may offer
a quicker return to work and normal activities with decreased pain for some patients.

Groin (Inguinal/Femoral) hernias
     Groin hernia repair is surgery to repair weakness in the abdominal wall of the groin.
The bowel that is pushing through the weak area is pushed back into its normal
place. The groin is the lower abdominal area where the legs join the body. There are
2 general types of groin hernias – inguinal hernia and femoral hernia. Surgery is the
main treatment for groin hernias which usually need to be repaired to avoid
complications. For example, after the bowel has pushed through the muscle wall, its
contents may become trapped. A dangerous complication is that the blood supply to
the bowel may be cut off and the trapped tissue may die, resulting in severe
infection.

     For surgery, you will be given a regional or general anesthetic. A regional or local
anesthetic is a drug that should keep you from feeling pain during the operation. A
general anesthetic relaxes your muscles, puts you to sleep, and prevents you from
feeling pain during the operation.

     The surgeon will make a cut in the lower side of your abdomen, push your intestine
back into the abdominal cavity, and cover the opening (the defect in the abdominal
wall). The surgeon may place a mesh over the weak spot in the abdominal wall,
creating a newer, stronger wall.