From the Guidelines
A hernia is a condition where an internal organ or tissue protrudes through a weakened area in the surrounding muscle or connective tissue, and its causes include increased abdominal pressure, obesity, age, and genetic predisposition. The most common types of hernias are inguinal (groin), umbilical (belly button), incisional (from previous surgery), and hiatal (upper stomach) 1. Hernias can be caused by several factors, including:
- Increased abdominal pressure from heavy lifting, persistent coughing or sneezing, pregnancy, constipation, or straining during bowel movements
- Obesity, which puts extra pressure on abdominal walls
- Age, as muscles naturally weaken over time
- Genetic predisposition, with some people born with weaker connective tissues
- Previous surgeries, which can create weak points where incisions were made
According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias, patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected 1. The guidelines also recommend that systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation 1.
In terms of treatment, surgery is typically the recommended course of action to push the protruding tissue back into place and repair the weakened area. This can be done through open surgery or laparoscopic procedures 1. Small, non-painful hernias might only require monitoring, but hernias that cause pain or complications like intestinal obstruction or strangulation require prompt medical attention and surgical intervention.
It's worth noting that the use of mesh in clean surgical fields is associated with a lower recurrence rate, and prosthetic repair with a synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection 1. However, for stable patients with strangulated hernia with bowel necrosis and/or gross enteric spillage, primary repair is recommended when the size of the defect is small, and a biological mesh may be used for repair if direct suture is not feasible 1.
Overall, the key to managing hernias is early detection and prompt treatment to prevent complications and improve patient outcomes. Prompt medical attention and surgical intervention are crucial in cases of intestinal obstruction or strangulation, and the choice of treatment depends on the individual patient's circumstances and the severity of the hernia 1.
From the Research
Definition of Hernia
- A hernia is defined as the protrusion of tissue, organ, or an organ constituent through an innate or acquired fault of the muscle or the connective tissue membrane 2.
- It can occur when an internal organ protrudes through a tear or weak spot in the abdominal muscles 3.
Types of Hernia
- Inguinal hernia, also known as groin hernia, is one of the most frequent surgical conditions and is more common in males 2.
- Obturator hernia is the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator canal and is more common in older malnourished women 4.
- Femoral hernia, umbilical hernia, and incisional hernia are other types of hernias that can occur 5.
Causes of Hernia
- Weakness in the abdominal muscles can cause hernias 3.
- Loss of supporting connective tissue and a wider female pelvis can contribute to the development of obturator hernia 4.
- Advanced age, concomitant diseases, and high American Society of Anesthesiologists (ASA) score can increase the risk of morbidity and mortality in patients with incarcerated abdominal wall hernias 5.
Risk Factors
- Older service members, males, non-Hispanic whites, and those in combat-specific occupations have higher incidence rates of inguinal hernia 3.
- Femoral hernia is more frequent in females, while inguinal hernia is more frequent in males 5.
- Intestinal strangulation and necrosis can occur in patients with incarcerated abdominal wall hernias, especially in those with femoral hernias 5.