DEFINITION OF HERNIA
The abdominal wall is a strong muscle
and connective tissue structure that surrounds the abdominal organs like an envelope and gives our body its shape. This envelope has some potential weak points. When intra-abdominal organs (especially fatty tissue and intestines) pass through the abdominal wall through these weak points and form a bulge under the skin, it is called a hernia. A hernia is also called a hernia. Abdominal wall hernias are treated surgically by General Surgery specialists. Conditions popularly called lumbar herniation or cervical hernia fall within the field of Brain and Nerve Surgery
specialists. In these cases, the disc-shaped structures between the vertebral bones come out by tearing the membrane around the spine and put pressure on the spinal cord or nerves.
Lumbar/cervical hernias and abdominal wall hernias, which are often confused due to their names, are different in the body.
As they occur in different regions and with different mechanisms, their treatments/treating doctors
are different.
TYPES OF HERNIA
There are some potential
weak points in the abdominal wall, both congenital and may develop later. Congenital points:
a. In men, both groin areas where the testicles, which are in the abdomen while in the womb, pass through the abdominal wall while coming to their normal
place in the scrotum. The groins are also weak in
women. In these areas, there is the inguinal canal and includes the vessels leading to the testicles and the seminal canal in men, and some suspensory ligaments of the uterus in women.
b. The umbilicus is the place where the veins that provide nutrition to the baby from the mother while in the womb enter the baby's body. After the baby's umbilical cord falls off, a hard scar tissue forms in this area
creating the usual appearance of the navel. However, the potential weakness of the area continues and in some people, an opening in the abdominal wall may occur in this area later in life. In babies, this opening mostly closes spontaneously within the first four
years of age. If it does not close or occurs at a later age/adult life, it must be treated with surgery.
c. It is the junction of the sheaths of the muscles located on both sides in the midline above the umbilicus level. i
line, epigastric region. The line where both muscle sheaths meet may at times be more flexible than
necessary, which may lead to a hernia-like appearance or sometimes to an opening in the abdominal wall.
d. Possible weak points located at the intersections of the muscles located layer by layer within the layers of the abdominal wall may
cause hernias with special names such as Spiegel's hernia or lumbar hernia.
Weak points that may occur later are in the abdominal wall. These are the incision areas that occur due to surgeries. During surgeries, incisions are made on the abdominal wall along with the skin, and these incisions are closed after the surgery is completed. During the healing process, these incisions are potential weak points and are risky for hernia formation. Negativities that will occur during the post-operative period increase this
risk.
In order for hernias to occur, the abdominal wall must be strained. Situations that increase intra-abdominal pressure
create this strain. Situations such as carrying excessive and long-term heavy loads, constipation that requires constant straining, and prolonged coughing increase intra-abdominal pressure. In addition, problems that may arise in the abdomen after surgery negatively affect wound healing, and thus prepare the ground for hernia. .
WHY DO WE TREAT?
There are many difficulties that hernia brings to your personal life. Symptoms vary. While small hernias
manifest themselves with pain, as the hernia grows, it causes a swelling under the skin, causing impairment in physical appearance and restriction in daily movements. This situation prevents the person from moving freely in society and damages his/her self-confidence. Since hernia is a growing and progressive disease unless
it is treated, it should be treated as soon as possible
after it is detected. In addition to relieving the complaints of the patients, in order to avoid more serious medical problems
wall hernias should be treated. As stated before, abdominal wall hernias occur when intra-abdominal organs pass through the openings in the abdominal wall, creating a swelling under the skin. Most of the time, organs are constantly at this angle. They enter and exit through openings.
From time to time, due to the high intra-abdominal pressure, a large volume of organs passes through the abdominal wall and settles under the skin, but due to the large volume, it cannot go back into the abdomen. This condition is called hernia compression and can lead to intestinal obstruction. If this
process is prolonged, the blood vessels feeding the organs will remain under pressure and may cause decay
, which is called strangulation of the hernia. Both conditions must be treated with surgery
under emergency conditions. Since surgery in emergency conditions may involve unpredictable risks for both the patient and the physician, surgical treatment should be performed as soon as possible under ideal conditions when a hernia is detected. This is much more comfortable for both the patient and the physician.
MUST THE TREATMENT BE SURGICAL?
The principle of treatment of abdominal wall hernias is basically the same as repairing a hole in a wall
. Therefore, it is clear that a mechanical problem must have a mechanical solution.
In today's conditions, there are no drugs or methods (exercise, etc.) that can close the openings in the abdominal wall by creating new and solid tissues. Until a better solution is developed, surgery will be the only option in the treatment of abdominal wall hernias. Inguinal ligament etc. Methods such as
do not solve the problem, they can only provide temporary relief.
TREATMENT
The basic principle of treatment is to repair an opening in the abdominal wall with a patch without tension. This
patch can be created from the body's own tissues, or some synthetic materials can also be used. With the development of new technology materials, the use of synthetic materials has become very widespread today. Synthetic patches are advantageous for tension-free repair. When the patch
is placed on the body, it is perceived as a foreign body by the body and a hard
tissue forms around it. This hard tissue ensures that the hole in the hernia area is closed in a strong and durable way.
Hernia surgeries can be performed by open or closed (laparoscopic) methods.
There is no difference in terms of success between the two methods, but in laparoscopic surgeries
Since the incisions are smaller, post-operative mesh are significantly less. While both repair with the patient's own tissue and synthetic patches can be used in open
surgeries, it is mandatory to use synthetic patches in laparoscopic surgeries. Considering that today's accepted ideal treatment for hernia
is repair with synthetic patches, this should not be seen as an advantage of open surgery. Especially in surgical hernias, it may be necessary to make large incisions in direct proportion to the size of the hernia. In such cases
, laparoscopic methods, which allow the problem to be solved through very small incisions, provide significant comfort for both the patient
and the physician. In large hernias, the laparoscopic method
shortens the hospital stay. Due to the comfort it provides to the patient in the post-operative period, the laparoscopic method is offered to the patient as the first choice in all types of hernia.
SURGERY PROCESS
In the vast majority of hernia surgeries (assuming there is no problem), it is performed in the hospital
/> stay is short. The duration of hospital stay for inguinal hernias and umbilical hernias that are not very large is one night. In surgery site hernias, this period may rarely take up to a week, depending on the size of the hernia. Applying the laparoscopic method will shorten the hospital stay. After the patient returns home, he is invited to the hospital for a control
examination on the seventh day of the surgery, and most of the time the patient does not need to come for another check-up regarding this situation; a doctor is consulted only in the presence of any complaints.
Repair of the abdominal wall. Since the surgery area is performed, it will be weak at the beginning, so
heavy exercise and strain should be avoided until the wound healing process reaches a certain stage. Patients can return to their daily lives 48 hours after the surgery.
The patient must rest for 3 to 7 days, depending on the intensity of his/her work and pain status. The vast majority can return to work (which does not require heavy physical activity) within 4-5 days. For those who do not do active sports, lifting heavier than 5 kg or doing heavy sports
is not recommended for six months. Active athletes should start routine training after 6 weeks.
POST-SURGERY PROBLEMS
The most important problem that may occur during or in the early post-operative period
is bleeding in the surgical area. Rarely, second surgeries may be required to control bleeding. During the surgery, especially in inguinal hernias, injuries to these tissues may occur, as they are operated very close to the seminal duct, testicular vessels and nerves in men. This situation may cause infertility, so it should be handled very carefully.
After a well-performed hernia surgery, if the risk factors related to the patient are not too high, the recurrence rate is quite low. After hernia surgery, the most difficult issue to solve is pain. Prolonged pain usually disappears over time, but in some cases, treatment options such as drug injection into the painful area and re-surgery may come to the fore.
It is very important that the patient does not gain weight after surgery to prevent the hernia from recurring.
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