Anterior abdominal wall hernias

What are they?

Anterior abdominal wall hernias are bulges in the contents of the abdominal cavity through defects in the abdominal wall. This "pushes out" the contents of the abdominal cavity - usually the small intestine and a large abdominal envelope - through the weak points of the connective tissue and/or muscle of the wall, which in addition to cosmetic problems can lead to pain, discomfort, but also possible dangerous complications.

How are they created?

Most anterior abdominal wall hernias are a combination of congenital factors (sites of reduced anatomical-embryonic wall strength, genetic predisposition to connective tissue weakness) and acquired factors (anterior abdominal wall muscular strain, sudden movements, increased intra-abdominal pressure in physiological or pathological conditions) conditions - eg in cases of obesity, constipation, cirrhosis, etc.). There is a "break" in the integrity of the abdominal wall and through this defect is slowly dislocating the contents of the abdominal cavity in the so-called “hernia sac”.

What types of hernias are there?

Concerning localization, we divide them into inguinal (inguinal), femoral, umbilical, epigastric, Spigeli's hernias, as well as postoperative hernias at the site of previous operations anywhere along the anterior abdominal wall.

Inguinal (inguinal) hernias are most common in men, although they are not uncommon in women. They occur in the inguinal canal, at the sites of earlier embryonic lowering of the testicles in men, ie the formation of the ligamentous apparatus of the uterus in women. Considering the position in relation to the inguinal openings, we divide them into direct and indirect, which is of less importance for patients. Any symptomatic inguinal hernia should be treated surgically, but all inguinal hernias have a relative indication, given the inevitability of their growth and development of symptoms, but also increasingly difficult to repair with large hernias.

Femoral hernias are less common and are almost exclusively found in women. They are located closer to the midline, below the inguinal ligament. They are characterized by an extremely narrow herniated neck and a high rate of entrapment and are an absolute indication of surgery.

Umbilical hernias are a common pathology, also often neglected by patients, as some of them believe that "they just have a fallen umbilical cord". Often characterized by a narrow neck, they are an indication for surgical treatment, as entrapment can - as with other hernias - mean a cessation of circulation to the affected intestine, where emergency surgery must be performed.

Epigastric hernias occur above the navel and are located in the midline, although the progression and growth of the hernia may develop asymmetry on a particular side.

Any previous abdominal surgery can result in the development of a hernia at the site of the surgical incision - then we are talking about a postoperative hernia. In modern times, we often encounter hernias in the "workplace - trocars" after laparoscopic operations on the bile or appendix.

Large ventral and Spiegel's hernias are less common pathological entities.

What can be complicated?

Delaying surgical treatment inevitably leads to an increase in EVERY hernia of the anterior abdominal wall, the development of increasing discomfort, tightness, "burning" and pain, and can lead to entrapment of the contents of the hernia sac, which is then an indication for emergency surgery, sometimes vital patient vulnerability. Contrary to popular belief, it's not just "big hernias" that get complicated. Smaller hernias are often prone to the development of entrapment, due to the "narrow neck" through which the contents of the abdominal cavity are "pushed".

How are they treated?

There is no way to "conservatively" treat a hernia, so surgical treatment is the only possible cure. In the treatment of inguinal hernia so-called. GOLD STANDARD is hernioplasty with the insertion of prosthetic material - the so-called. MESH acts as a kind of reinforcement and encourages the body to create its binder at the site of hernia repair. Such an approach is characterized by the absence of tension (so-called "non-tension hernioplasty"), which leads to a dramatically lower risk of recurrence (recurrence of hernia), as well as to a lower rate and degree of postoperative pain. The operation can be performed by open access (Lichtenstein method) or laparoscopically (TAPP or TEP).

Umbilical and other minor hernias in the midline, as well as extremely small hernias at the sites of previous operations, can be treated by direct repair (direct suturing of the wall defect), with or without mesh insertion - depending on the size and shape of the wall defect.

What does the operation look like?

Depending on the type, size, and location of the hernia - the procedure can be performed under local, spinal, or general anesthesia. No significant blood loss is expected. During the operation, the integrity of the wall is re-established with or without the insertion of prosthetic material, hernia bags are removed, and the contents are returned to the abdominal cavity. In the OPEN ACCESS, the structures of the inguinal canal are dissected and a mesh is placed on the anterior side of the muscles of the anterior abdominal wall. The muscular fascia is closed, and the skin and subcutaneous tissue are sutured with individual sutures, of which only skin sutures need to be removed after 10-12 days. In the LAPAROSCOPIC APPROACH, the same procedure is performed through the abdominal cavity (TAPP) or in the layers of the wall itself (TEP) through several smaller incisions (incisions) to access trocars - working instruments of this minimally invasive method, without an incision in the groin or larger incision on the anterior abdominal walls.

How long does recovery take?

Most anterior abdominal wall hernias can be operated on in the course of one-day surgery. The patient goes home a few hours after the operation, with a recommendation to refrain from physical exertion and instructions for wound hygiene.

Full readiness for stronger physical effort is reached about 8 weeks after surgery since the process of creating new connective tissue and "healing" muscles and fascia is much slower than the healing process of the skin, which takes about ten days.

About laparoscopy

Laparoscopy is a minimally invasive method in abdominal surgery during which surgery is performed through multiple smaller incisions (5 to 15 mm) using long, narrow instruments and working trocars. It is most often used in operations on hernias (hernias) of the anterior abdominal wall and operations to remove the gallbladder, but it also has its place in more extensive procedures such as operations on the colon and small intestine and parenchymal organs of the abdominal cavity. In order to minimize tissue trauma, the great advantage it brings is the shortened time of many operations, faster postoperative recovery, and better cosmetic results in terms of reducing scars. Because of all the above, patients return to their daily functions and habits faster.