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What is a hernia? — Your internal organs and tissues are held in place by a tough outer wall of tissue called the “abdominal wall.” An abdominal hernia is an area in that wall that is weak or torn. Often when there is a hernia, organs or tissues that are normally held in place by the abdominal wall bulge or stick out through the weak or torn spot.
There are many different kinds of abdominal wall hernias:
What are the symptoms of abdominal wall hernias? — Abdominal wall hernias do not always cause symptoms. When they do, they can cause some or all of these symptoms:
A bulge somewhere on the trunk of the body – This bulge can be so small that you don’t even realize it’s there.
Pain, especially when coughing, straining, or using nearby muscles
A pulling sensation around the bulge
Abdominal wall hernias can balloon out and form a sac. That sac can end up holding a loop of intestine or a piece of fat that should normally be tucked inside the belly. This can be painful and even dangerous if the tissue in the hernia gets trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can become swollen or even die.
Should I see a doctor? — Yes. See a doctor if you have any of the symptoms of a hernia. In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor might ask you to cough or bear down while pressing on your hernia. This might be uncomfortable, but it is necessary to find the source of the problem.
Most of the time, the contents of the hernia can be “reduced,” or gently pushed back into the belly. Still, there are times when the hernia gets trapped and won’t go back in. If that happens, the tissue that is trapped can get damaged.
If you develop pain around a hernia bulge or feel sick, call your doctor or surgeon right away.
How are hernias treated? — Not all hernias need treatment right away. But many do need to be repaired with surgery. Surgeons can repair most hernias in 1 of 2 ways. The right surgery for you will depend on the size of your hernia, where on the abdominal wall it is, whether this is the first time it is getting repaired, and what your general health is like. The types of surgery are:
Open surgery – During an open surgery, the surgeon makes an incision near the hernia. Then he or she looks at the tissue that is stuck in the hernia, and if it is healthy, gently pushes it back into place. Sometimes a piece of tissue needs to be removed. Next, the surgeon sews the layers of the abdominal wall back together, so that nothing can bulge through. In some cases, surgeons will also patch the area with a piece of mesh. The mesh takes some of the strain off the abdominal wall. That way the hernia is less likely to happen again.
Laparoscopic surgery– During laparoscopic surgery, the surgeon makes a few incisions that are much smaller than those used in open surgery. Then he or she inserts long thin tools into the area near the hernia. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide his or her movements. Then he or she uses the long tools to repair the hernia using mesh.
If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine. Then he or she will sew the intestine back together.
The recovery and aftercare for each type of hernia repair is different. Your doctor or nurse can tell you what to expect after your surgery.
Component separation repair of large or complex abdominal wall defects
An increasing number of patients have large or complex abdominal wall defects. Such defects may result from incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, necrotizing abdominal wall infections, or therapeutic open abdomen. The component separation technique, which was first described in 1990 for midline abdominal wall reconstruction, is a type of rectus abdominis muscle advancement flap that allows reconstruction of such large ventral defects. The advantages of the component separation technique are that it restores functional and structural integrity of the abdominal wall, provides stable soft tissue coverage, and optimizes aesthetic appearance.
INDICATIONS - Large or complex abdominal wall defects may be associated with problems such as chronic back pain, respiratory compromise, and altered body image. Patients with symptoms related to these defects or incisional hernias should ideally be repaired.
Large or complex abdominal wall defects are a particularly challenging surgical problem. Various methods of abdominal wall hernia repair (simple suture repair, mesh repair) using either open or laparoscopic approaches can be used to manage abdominal wall defects, which are most commonly related to incisional hernia.
The component separation technique, which was first described in 1990, is a very effective method for reconstructing large or complex midline abdominal wall defects in a manner that restores innervated muscle function without tension sometimes without the need for mesh.
Indications for a component separation technique include the following:
The component separation technique can restore abdominal wall functionality for defects up to 20 cm at the level of the umbilicus. In some patients with extremely large defects, the component separation technique alone may not allow restoration of the abdominal wall without tension. If the defect is too large to allow the flaps to be brought together at the midline, supplemental mesh can be used to bridge the residual defect.
