A hernia can be defined as the protrusion of intra-abdominal organs through a weak area, usually in the abdominal wall or in another cavity of the body (chest cavity, etc.). The reason for the formation of this weak area may be congenital or acquired.
HOW MANY TYPES OF HERNIA ARE THERE?
- Inguinal hernia (inguinal hernia)
- Umbilical hernia(umbilical hernia)
- Postoperative incisional hernia(incisional hernia)
- Besides these three common hernia types, there are other rare abdominal wall hernias (lumbar–Grynfeltt – parastomal hernias etc…) can be seen.
By the way, there is another type of hernia that I find useful to mention. This hernia is both common and popularly called "stomach hernia", but this hernia is not in the "abdominal wall hernia" group. This hernia, which we call "hiatus hernia", originating from the junction of the stomach and esophagus and forming when a part of the stomach passes into the chest cavity, is one of the main diseases that causes "reflux" complaints in patients.
INGUINAL HERNIA. HOW DOES IT OCCUR?
Inguinal hernias are the most common abdominal hernias. They are seen in 2-5% of the population. It is more common in men (85%) than women (15%). The reason why it is more common in men is the potential weak area that develops in the abdominal wall due to the path of the testicles in the abdomen during embryonic development to the scrotum (bag) after birth. An inguinal hernia develops as a result of this area not closing completely during the embryonic period or opening as a result of strain in the later period. There are 3 types of inguinal hernias.
- Indirect inguinal hernia,occurs on the path of the testicles to the scrotum (eggs to the sac) and is usually a hernial sac that continues with the abdominal membrane (peritoneum). available. This sac can extend to the scrotum (bag) in men and the labia (vaginal lips) in women.
- Direct inguinal hernia, This type of hernia occurs through a weak point on the back wall of the inguinal canal. A herniation occurs from the abdomen directly under the skin. It is the herniation of the intra-abdominal organs through the gap in the femoral canal through which the feeding artery, vein and nerve pass. It is more common in older women; 85% of hernias in women are femoral hernias. Pain and swelling are mostly below the groin area, and pain may also radiate to the thigh. The possibility of strangulation is high and diagnosis may be difficult.
HOW DOES UMBILICAL HERNIA OCCUR?
It forms the connection between the mother and the child before birth and the growth of the child. The veins that provide the necessities for the body pass through the umbilical ring. These vessels are located within the structure called the "umbilical cord" and close after birth. The swelling that occurs in the belly due to the entry and exit of intra-abdominal organs through the gap in the umbilical ring that has not yet closed completely is called "umbilical hernia". These hernias are usually congenital and can close spontaneously within the first 4 years.
However, "umbilical hernias" may also occur in adulthood, as the umbilical ring creates a weak area in the abdominal wall. These constitute 8-10% of all hernias and are mostly seen in women. As in most hernias, conditions that increase intra-abdominal pressure in umbilical hernia (such as pregnancy, chronic cough, constipation, lifting heavy loads, etc.) can be considered among the main causes.
"POST-OPERATIVE INCISION HERNIA" HOW DOES IT OCCUR?
These are hernias that occur at the surgical incision site after abdominal surgeries. Factors such as the presence of systemic disease, surgical site infection, obesity, and advanced age are among the reasons that increase the occurrence of "post-operative incisional hernia". It is usually seen in 1-10% of patients who have abdominal surgery. In the early period after abdominal surgery, various factors that increase intra-abdominal pressure, as well as challenging physical movements, may also contribute to this issue.
HOW ARE ABDOMINAL WALL HERNIAS DIAGNOSED?
<HOW IS THE TREATMENT OF ABDOMINAL WALL HERNIAS?
Treatment for all hernias is only surgical.
INGUINAL HERNIA REPAIR,
- Open surgeryinterventions, Treatment of direct and indirect inguinal hernias, Lichtenstein, Shouldice, Bassini etc. It can be performed using techniques. In these surgeries, strengthening is usually done with a patch. Application of the patch to the hernia area should be without tension, so that pain and the risk of recurrence of the hernia can be reduced.
- With closed surgical (laparoscopic)interventions, direct and indirect inguinal hernias can be removed. Treatment is performed by two different laparoscopic methods identified with the letters TAPP and TEP.
TAPP (Closed repair performed through the abdomen) In this repair, approximately 0.5-1 cm is inserted into the abdominal cavity. By entering through incisions with special tools, the hernia area is closed by placing the patch at the level of the abdominal membrane and fixing it to the surrounding area. It is preferred in stuck and giant inguinal hernias.
TEP (total extraperitoneal closed repair) In this repair, the work is done in the space created by a balloon between the abdominal membrane and the fascial plane, without entering the abdominal cavity. and a patch is placed in front of the abdominal membrane, on the ring where the hernia originates, and its fixation is made.
UMBILICAL HERNIA REPAIR,
- Open In the repair, the procedure is chosen according to the size of the hernia. If the size is small, primary repair is preferred, and if it is large, patch repair is preferred. It is performed with the help of special tools inserted into the abdominal cavity through 0.5 cm incisions. In this method, regardless of the size of the hernia, the hernia area is closed with patch application in every case.
OPERATING SITE HERNIA REPAIR,
- Open repair should be preferred, especially in cases that are not suitable for laparoscopic intervention. It is often necessary to use a patch.
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Closed (laparoscopic)repair, if the adhesions due to previous intra-abdominal surgery are not at a level that prevents the intervention from being performed and the characteristics of the patient do not prevent this procedure from being performed. If it does not, it should be preferred.
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