Health and Fitness

Abdominal Wall Hernia Repair

An abdominal wall hernia is an opening or area of weakness in the abdominal wall through which abdominal matter can sometimes protrude and form a bulge. Such drawing out of matter from an abdominal cavity can consist of fatty lining, a part of stomach or intestines from the body.

Causes of Abdominal wall hernia

Abdominal wall hernia can occur due to injury, chronic coughing, heavy weightlifting, constipation, excessive body fat, pregnancy, smoking, and aging. All of these factors can cause strain as well as create pressure on the muscle joints of the abdominal region.

Types of Abdominal wall hernia

(1) Inguinal hernia

can occur when the intestine or fat matter from the abdomen bulge through the lower abdominal wall into the groin area.

Indirect Inguinal Hernia is congenital in nature but is seen in older people too

Direct Inguinal Hernia is more commonly seen in males compared to females and it is associated with weakness of the abdominal wall

(2) Femoral hernia

may occur more in females as they have wider bone structure compared to males and it is formed through the opening of the abdomen floor as there is a gap for the femoral artery and vein to pass from the abdomen into the upper leg.

(3) Obturator hernia

is developed between the obturator and the pectineus muscles. It is a very rare type of abdominal hernia caused among females having multiple pregnancies, an excessive amount of weight loss, or aging problems.

(4) Epigastrium

hernia, as the name suggests Epigastrium means ‘located over the stomach.’ It is formed between the belly button and sternum. They can be congenital but generally tend to develop in adulthood.

(5) An umbilical hernia

creates a soft swelling or bulge near the navel. Before the birth of a baby, the umbilical blood vessels pass through the umbilical ring which is an opening in the abdominal muscles to give food to the foetus. An umbilical hernia is caused by the unfinished closure of the umbilical ring after childbirth.

(6) Spigelian hernia

is very rare and asymptomatic in nature. They are developed through the spigelian fascia, the muscles located at the outside edges of the rectus abdominis muscles in abdominal walls.

(7) Incisional hernia

occurs due to the weakening of abdominal muscle after the surgical incision. An incisional hernia can occur for a number of reasons such as individuals who participate in excessive or premature physical activity after surgery, pregnancy as well as a drastic change in weight of the body.

All the above hernias can be treated with multiple techniques. Hernia surgeons are trained in various techniques to handle complex problems. Dr. Rengan is a senior hernia surgeon trained in some of the best centers in the world. He will listen to your problems and advise you on the right way to proceed.

Surgical Methods to Treat Hernia Repair

A surgeon can conduct hernia repair through open surgery or laparoscopic surgery.

Conducting an Open Surgery

To conduct an open hernia repair, a surgeon injects local anesthesia into the spine to keep the area being operated numb. The surgery can also be done under spinal or general anesthesia.

Further on, the surgeon makes a single cut over the hernia which is typically 6 to 8cm long. The lump of fatty tissue or loop of the bowel is placed back into the patient’s abdomen.

➢ The surgeon places a mesh in the abdominal wall, at the weak spot where the hernia came through, to strengthen it.

➢ After the repair, the skin is sealed with stitches.

Conducting a Laparoscopic Surgery

➢ In a laparoscopic surgery of a hernia repair, the anesthetist gives general anesthesia to the patient, thus he is asleep during the operation.

➢ The surgeon usually makes 3 small incisions in the abdomen instead of one larger incision.

➢ A laparoscope (a thin, telescope-like instrument) is inserted through one of these incisions.

➢ The laparoscope is connected with a video camera which is smaller than a coin, to provide an inside view of the patient’s body on television screens.

Following are the 2 types of Laparoscopic surgery:- 

  1. Transabdominal preperitoneal (TAPP)

In transabdominal preperitoneal, the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over the hernia to strengthen the weak area.

  1. Totally extraperitoneal (TEP)

While in totally extraperitoneal the peritoneal cavity is not entered, and mesh is utilized to cover up the hernia from outside the peritoneum (the thin membrane that covers the organs in the abdomen).

After the surgery is complete, the incisions in the patient’s skin are sealed with stitches or surgical glue.

Advantages of Laparoscopy for the patient:

As compared to getting a traditional open surgery, laparoscopy has added advantages for the patient that include the following:

  1. The patient will have relatively smaller scars.
  2. The patient will be discharged earlier from the hospital.
  3. He/she will feel lesser pain and the scars heal would heal faster.
  4. He/she can resume the routine life more quickly.
  5. There will be less internal scarring.
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