Hernia

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What is Hernia?

3D Animation on
Inguinal Hernia

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Hiatal Hernia

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A hernia is any structure passing through another which in doing so ends up in the wrong place. Formally, it is defined as the protrusion of a loop or knuckle of an organ or tissue through an abnormal opening.

An inguinal hernia is most common - these occur in the area of where the skin crease at the top of the thigh joins the torso (the inguinal crease) and appear as a bulge.

Other Hernias:

Femoral hernia - bowel enters the femoral canal presenting as a mass in the upper, inner thigh.

Umbilical - through umbilicus (the belly button area).

Paraumbilical - just above or below the umbilicus.

Epigastric - pass through linea alba (midline abdomen) above the umbilicus.

Incisional hernias - follow breakdown of muscle closure after previous surgery.

Lumbar - through one of the lumbar triangles

Richter's - this is when the bowel wall only, not the bowle opening is involved.

Obturator - through the obturator canal. Typicallly there is pain along the inner side of the thigh in a thin women.

Who gets Hernia?

Groin hernias occur in approximately 2% of the adult population and 4% of infants.

Their relative frequencies are as follows:

Inguinal 80%
Incisional 10%
Femoral 5%
Umbilical 4%
Epigastric <1%
Other: <1%

Inguinal are approximately 10 times more common in males, while femoral and paraumbilical are more common in women.

Predisposing Factors

Predisposing factors include

Increased intra-abdominal pressure: Chronic cough, constipation, urinary obstruction, heavy lifting, ascites (fluid in abdomen), previous abdominal surgery, obesity.

Loss of tissue strength and elasticity (direct inguinal hernia).

Nerve damage with consequent weaknening of the muscles.

Residual embryological channels in the case of congenital herniae (defects that one is born with).

Family History

Progression

The natural history of most herniae is that they will slowly increase in size although may remain the same size for an extended period. They do not spontaneously heal and are at risk of the complications described and thus need to be repaired surgically.

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