Hernia is a condition in which an internal organ protrudes from its normal place through a weak point in the body, and forms a lump under the skin. Swelling occurs and disappears from time to time. Swelling appears usually when straining up, coughing, and straining, and disappears when lying back. The reason of why swelling disappears when lying back is that the organs in the hernia sac go back into the abdomen. The internal organs forming a swelling in the abdominal wall are usually the intestines.
Congenital or acquired factors affect the mechanism of hernia formation. Congenital factors are less but effective in the mechanism of hernia formation in adults. However, weight gain, constipation, persistent cough, lifting heavy things, and every motion that strains the abdominal muscles are more effective at these ages.
Hernias of the abdominal wall protrude from a congenital or acquired weak point. Inguinal hernias, umbilical hernias and hernias around the navel are the examples for hernias that protrude from a congenital weak point. The acquired weak points are the sites of surgical operations. Hernias that occur where a surgery has previously done are called ‘incisional hernias’. Certain cases such as lifting heavy things, chronic constipation, coughing, straining, tenesmus, which suddenly increase intra-abdominal pressure in such people, pave the way for the formation and emergence of an existing hernia.
Hernia is a disease seen in 2-4 percent of the society. It progresses with loss of workforce, loss of strength, deterioration of the quality of life, and sometimes a vital danger.
What are The Types of Hernia ?
It can be an inguinal hernia, as the most common type of hernia; umbilical hernia, as a less common type of hernia; and epigastric (upper abdominal mid-line) hernia or hernia in the side and rear abdominal walls, as a very rare type of hernia.
In addition, herniation of internal organs (e.g. the stomach) can be encountered, which shows a variety of symptoms before diagnosis, such as heartburn or chest pain.
Umbilical hernias protrude from the navel or areas close to it, and their bigness varies from the size of a hazelnut to the size of an orange. Umbilical hernias are more common in women, and are noticed by patients mostly during pregnancy. The navel, normally should be inward, is bulged outward. In some women, the umbilical hernia can disappear at the end of pregnancy. If the hernia still exists despite the completion of the pregnancy, it should be treated.
Why does an Umbilical Hernia Occur ?
The area in the abdomen, from where the hernia protrudes, is a congenital area of weakness. The place, where the umbilical hernia protrudes, is the connection point of the umbilical cord that provides the blood flow between mother and baby when the baby is in the womb. Umbilical cord falls off within a few days after birth, and this is called ‘falling off of the baby’s umbilical cord’. This area needs to be completely closed. If it is not closed completely, a pediatric umbilical hernia occurs, and if it is reopened in adulthood period after its closure, an adult umbilical hernia occurs. Therefore, umbilical hernias are hernias that protrude from a “congenital area of weakness”.
What is the Treatment of the Umbilical Hernia ?
There is a tendency of repairing small umbilical hernias with direct suture without patch; but in our medical center, all umbilical hernias are repaired with patches. It is because the European Society of Hernia suggests that repairing all umbilical hernias with patches is a more appropriate way in terms of the prevention of recurrences. Umbilical hernias repaired without patch, even small ones, have been found to have a high rate of recurrence.
When umbilical hernias are small, they can be repaired under local anesthesia. Generally, it is possible to discharge the patient on the day of surgery. Patients return to their routine activities and works within a short period of time. When repaired with patches, umbilical hernias are very less likely to recur.
What is the Risk if Umbilical Hernias when they are not Treated ?
When umbilical hernias grow, they pose an increased risk of ‘strangulation of hernia’. The risk of strangulation is higher in umbilical hernias compared to other hernias. Therefore, it would be proper to repair umbilical hernias, even if they are small. In such cases, the hernia that could previously be taken away when pushed manually is now cannot be pushed into its place. Strangulation of hernia, an emergency case, causes pain and redness in the area.
Incisional (Surgical Site) Hernia
They are hernias that protrude from incision sites of patients who have undergone a surgery. Incisional hernias may emerge in the early period after the first surgery or many years later. Incisional hernias may be caused by reasons arising from the patient or surgery. Selecting wrong surgical procedures or instruments to be used during the surgery as well as their misapplication are the reasons arising from the surgery. And the reasons arising from the patient are diabetes, anemia, chronic heart disease, chronic lung disease, eating disorders, collagen tissue disease, systemic diseases such as cancer, and the use of drugs that impair wound healing. No matter what its reason is, incisional hernias should be repaired in the most reliable and safe way, by considering that the previous problem may be still continuing. Otherwise, they can easily recur.
Incisional hernias can reach very large sizes in a short time: They are technically the most difficult hernias, despite that the difficulty varies depending on the size of the tear in the abdominal wall. The source of the difficulty is the fact that in cases of very large hernias, such as abdominal wall tears having a diameter of up to 15-20 cm, it may be impossible to align and then suture and close the two edge of the peritoneum because of inadequate amount of soft tissue that remained under the skin.