The term hernia is used to describe the protrusion of a body part or organ through an opening or defect in the fascia, muscle, or wall of a cavity. The fibrous lining of the abdominal cavity that supports, separates, and unites the muscles and tissues is known as fascia. In a hernia, the involved body part or organ is usually contained within the confines of the cavity, and upon herniation, is considered out of place. Hernias are generally found in the abdominal cavity, and can be asymptomatic or may produce a lump, ache, pain, or bulge at rest or with straining. A defect or opening in fascia can be congenital or acquired. Hernias can be lined or covered with tissue and this is known as a hernia sac.
Activities and conditions that increase the intraabdominal pressure such as heavy lifting, pregnancy, and obesity can lead to or accentuate an abdominal wall weakness manifesting itself as a hernia. There are several descriptive terms used to further classify hernias. A reducible hernia is one that returns to the cavity where it belongs via an application of pressure to it, or from a positional change. An incarcerated hernia is one that becomes trapped and cannot be reduced or returned to the cavity. When an incarcerated hernia becomes squeezed in such a way that blood supply to the organ or body part is compromised, it is known as a strangulated hernia. This is a condition that requires immediate surgical intervention.
Hernias are also described by their anatomic location. For example, a scrotal hernia describes a protrusion into the scrotum. Hernias of the lower abdominal wall can occur in the groin and are known as either inguinal or femoral hernias, depending on specific anatomical location. Femoral hernias are more common in women than men.
Groin hernias are the most common type of hernia. Inguinal hernias are further classified as direct or indirect based again on specific anatomical considerations, and how and where the protrusion occurs. Congenital and acquired umbilical hernias occur at the umbilicus due to a defect in the ventral abdominal wall and are commonly seen in obese people and pregnant women. Umbilical hernias can resolve spontaneously in children without sequelae, but frequently incarcerate or strangulate in adults. A hernia that appears at the area of a previous surgical site is known as an incisional hernia. A phrenic hernia occurs when an organ protrudes through the diaphragm. The hiatus (opening) of the diaphragm where the esophagus passes through can be the site of a hernia. The stomach may herniate or protrude through this opening resulting in a hiatal hernia. This type of hernia is considered a sliding hernia if it returns or slides back into the cavity where it belongs. Other types of abdominal hernias may also be sliding hernias.
Hernias can contain part or all of an organ inside the abnormal protrusion. For example, a Richter’s hernia describes a hernia in the abdominal cavity where only part of the bowel circumference is involved. If the brain protrudes where it does not belong, it is called a cerebral hernia. Hernias are also named for the organ that is out of place. For example, an ovarian hernia contains an ovary as the misplaced and protruding organ.
The only way to correct a hernia is with surgery, and this is known as herniorrhaphy. There are several different techniques used to repair abdominal wall and groin hernias such as various suture methods, surgical mesh placement, and laparoscopic repair. The best surgical technique for hernia repair remains controversial. Herniorrhaphy is one of the most frequently performed general surgery procedures.
The diagnosis of hernia is frequently made clinically based on physical examination, but imaging modalities do exist to confirm, elaborate, and aid in diagnosis. Complications associated with hernia repair include recurrence, infection, bleeding, and pain. Complications associated with not repairing abdominal wall and groin hernias include a small risk of incarceration and strangulation and thus a surgical emergency. The surgical correction of an uncomplicated, asymptomatic hernia versus watchful waiting remains a decision between the surgeon and the informed patient.
Gastroesophageal Reflux/Hiatal Hernia.
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