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What is a hernia?

Basically, a hernia is a "hole." The type of hernia gets its name basically from whatever it is a "hole" or "defect" in. 

Hernias:

When a hole or defect develops in the lining of the body, tissues and/or organs can squeeze out through the hole and form a bulge or swelling on the outside. While there are many different types of hernias, the most common ones occur in the abdominal (belly) or inguinal (groin) areas.

Hernias are quite prevalent, and hernia surgery has been steadily increasing worldwide over the last 20 years. Although there is no precise data, there are over 1 Million hernia repairs performed in the US every year. Globally, there were 4.17 Billion hernia surgeries performed in 2017, and at the current rate of increase, it is estimated to reach 6.37 Billion by 2025.

As noted above, most hernias are noticed by the individual themselves when they discover a bulge or swelling on the outside of the abdomen or groin. Most of the time they are not painful, but sometimes people note pressure or an aching discomfort, especially as they get bigger over time. Sometimes, it is pressure or pain that draws the attention of the person to the bulge. Hernias typically become bigger over time, and as they do, they often become uncomfortable. The bulge often becomes larger with any straining or strenuous activity, such as lifting, sports, coughing, sneezing, or straining to have a bowel movement, basically anything that increases intra-abdominal pressure. These activities also tend to cause pain or increased pain if you have pain associated with the hernia. People with hernias also frequently notice that hernia goes away from time to time, especially after sleeping, but then it comes back when they get back up on their feet or do any strenuous activity as noted above. Hernias disappear and come back when the tissue that protrude go "back in" to the abdominal cavity and re-appear or "pop out" when they squeeze out again through the hole.  

If you have any of these symptoms, you should see your doctor or come see us at Advanced Hernia Specialists as soon as possible.

Most hernias occur through a natural hole and the most common forms of hernia are:

Groin Hernias:

Have a prevalence of approximately 1700 per 100,000 individuals for all ages and 4000 per 100,000 for those aged over 45 years worldwide. They make up over 90% of hernias in men and 40% of hernias is women.

Inguinal hernia:

  • Approximately 75% of hernias are inguinal and occur in both males and females, but they are much more common in men (19:1). It is estimated that there is a global incidence of 18.9 million. Inguinal hernias have a lifetime risk of 27% in men and 3% in women. 95% per cent of patients that are diagnosed by their primary care doctor are male, and in men the incidence of inguinal hernia rises from 11 per 10 000 men aged 16-24 years to 200 per 10 000 men aged 75 years or above.​

    • An estimated 1 in 4 men and 1 in 50 women will require surgery for an inguinal hernia during their lifetime.

    • Repair of inguinal hernia is one of the most common operations in general surgery, and although there is no precise data, it is estimated that there are 500,000-750,000 inguinal hernia repairs performed in the US every year.​

    • In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that is attached to the uterus. Intestine, fat, or the bladder can protrude into the groin near the top of the inner thigh.​

Femoral hernia: (3% in men and 11% in women)

  • Very similar to inguinal hernia above, but it occurs when the same type of tissues protrude into the groin near the top of the inner thigh but through the canal where the "Femoral" blood vessels (artery and vein) pass through the abdominal wall. Femoral hernias are much less common overall than inguinal hernias. Conversely however, femoral hernias are much more common in women, and predominantly affect older women, who tend to have weaker pelvic floor anatomy. This type of hernia also tends to be much more dangerous and often need emergency repair when initially noted.

Abdominal Hernias:

  • Umbilical hernia: (2% of adults, and more common in women by a ratio of 3:1) Occurs when fat from inside or intestine can protrude through the abdominal wall near the umbilicus (belly button). This type of hernia also occurs through a natural hole, the one where the umbilical cord once came through the abdominal wall as a newborn.

  • Epigastric hernia: Similar to an umbilical hernia, but typically occurs from a hole where the abdominal wall did not complete fuse in the midline during development. These can be tiny holes and occur anywhere in the midline of the abdomen along a line from the umbilicus (belly button) and the sternum (breastbone).

  • Hiatal or hiatus hernia: (Estimated prevalence of 15% to 20% of people) Is another natural hole, one that occurs through the diaphragm where the esophagus (swallowing tube) travels into the abdomen. The diaphragm is a large muscular wall that separates the chest cavity from the abdominal cavity, and therefore the esophagus, which starts in the throat, must travel through the chest and into the abdomen to connect with the stomach. The esophagus must therefore travel through the diaphragm, and that place is called the "diaphragmatic hiatus." A hiatus hernia, therefore, occurs when a part of the stomach (sometimes a large portion or all of it) pushes up through this opening and into the chest cavity. With part of the stomach in the chest, it causes a loss of the barrier that keeps stomach acid from splashing up into the esophagus. Therefore, the most frequent symptom of a hiatus hernia is acid reflux, also called gastroesophageal reflux (GERD). A hiatus hernia is one of the most common causes of frequent or persistent GERD. The larger the hole becomes, the more stomach can protrude, which can then cause regurgitation, vomiting and/or severe pain.​​

  • Spigelian hernia: (estimated to make up 0.12% of all abdominal wall hernias) This rare and unusual hernia is a hole or defect in the seam where the rectus muscles (six-pack muscles) meet the lateral abdominal wall muscles (oblique and transversus abdominis muscles. 

  • Diaphragmatic hernia: Similar to a hiatus hernia, but in an area of the diaphragm other than the diaphragmatic hiatus. This can occur as a result of malformation in fetal development, from previous surgery of the diaphragm, or from trauma. The majority of adult-onset diaphragmatic hernia is associated with trauma. Blunt thoracic and abdominal trauma (like a car accident or fall) is associated with a 5% to 7% incidence of diaphragmatic injury, and in 3% to 15% for those with penetrating injury (gunshot or stabbing). With a diaphragmatic hernia, abdominal organs can protrude or herniate up into the chest cavity.

  • Incisional hernia: (Incidence varies widely from study to study but is estimated to range anywhere from 2% to 20% of people after abdominal surgery). Several studies have shown that for the 1-2 Million open abdominal surgeries performed per year, 1 in 4 patients will develop a ventral (abdominal wall) hernia.

    •  Intra-abdominal fat, intestine, or other organs protrude through the abdominal wall at a site where the patient has a scar from a previous abdominal surgery.

Hernias need to be repaired because they will not heal on their own. There is no lotion, potion, medication, exercise, or physical therapy that will cure a hernia. Hernias require surgery to repair. Just as hernias are so common, so is hernia surgery. Hernia surgery has been described going back to at least as early as 1145 BC, as it was discovered that the Egyptian mummy of Ramses V was found to have evidence of a groin hernia repair over 3100 years ago!!

Hernia repair has certainly evolved since then and has changed substantially over the 20+ years that I have been in practice. I have watched the evolution of hernia repair over the course of my career and it has been a major interest of mine, so much so that I chose to specialize in it. There are many methods of repair now, many modalities, and many approaches, which have all been shown to be very safe and effective (though some more effective or durable than others). These surgeries typically have low complication rates and short recovery times.

The most common hernias can be repaired on an outpatient basis in a surgery center, thus avoiding the complexities and increased costs of a hospital. 

At our center, patients with uncomplicated umbilical or inguinal hernias go home a short time after surgery and typically go back to work in 1 week or less after surgery. Thus, you can get back to your life with very little downtime.  

Next Steps

Come and see us at Advanced Hernia Specialists, spend time exploring our website, or just give us a call to learn more. We have the most experience and are experts in the field of hernia surgery. We are committed to delivering excellent care and the best patient outcomes possible. We offer the most cost-effective options for patients who are paying out of pocket, as well as the most advanced laparoscopic, minimally invasive, and robotic surgical techniques for hernia repair.

If you have groin pain and/or think you have a hernia, please schedule an appointment with us by calling 904-808-5658, emailing us​, using our online Contact Form, or Booking Online

 

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