Patient education: Abdominal wall hernias (The Basics)

What is an abdominal wall 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 (figure 1).

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

●Nausea or vomiting if part of your intestine is blocked in the hernia

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 (figure 2).

Should I see a doctor or nurse? — Yes. See a doctor or nurse 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 3 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, what your general health is like, and your surgeon's experience. The types of surgery are:

●Open surgery – During an open surgery, the surgeon makes an incision near the hernia. Then they look 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 they insert 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.

●Robotic surgery – During robotic surgery, the surgeon controls a robot to move tools like the ones used in laparoscopic surgery. In robotic surgery, the tools can move more precisely and twist and turn more easily. It is also easier to sew using these tools. Mesh is also used for robotic repair of abdominal wall hernias.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine. Then most times they 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.

More on this topic

Patient education: Groin hernias (The Basics)
Patient education: Groin (inguinal) hernias in children (The Basics)
Patient education: Congenital hernia of the diaphragm (The Basics)
Patient education: Hiatal hernia (The Basics)
Patient education: Small bowel obstruction (The Basics)
Patient education: Seroma (The Basics)