An abdominal hernia is a protrusion of abdominal content through the fascia of the abdominal wall. It can be a true hernia where there is a congenital defect such as an umbilical hernia, or a postoperative hernia due to dehiscence of deep layers of abdomen. A pseudohernia is an abnormal bulge due to weakness of the rectus sheath and muscles of the abdominal wall.
Common hernias of abdomen (Pseudo and true) include:
- Epigastric Hernia: In this condition there is a bulge above the umbilicus and is most common in young men. It can be a small asymptomatic hernia or a tender and painful bulge. Obesity and increase in intrabdominal fat can increase the hernia. Surgical repair is essential to prevent incarceration of abdominal contents.
- Umbilical Hernia: They are often congenital but can develop at later age. Adult umbilical hernia is more common after multiple pregnancies, abdominal obesity etc. Sometimes it can increase in size and can be painful. Hernia can be repaired either by preserving umbilicus if it is small to moderate or by removing the umbilicus if it is very large or recurrent.
- Incisional Hernia: It happens after surgery or traumatic wounds and can be due to inadequate repair of the wound or inability to heal by the body. They cause bulge along the line of the scars and can increase in size in chronic smokers, abdominal obesity etc. They require surgical repair and reconstruction of the abdominal wall with or without mesh reinforcement.
- Diversification of Recti: This is due to weakness and separation of the rectus muscle of the abdomen and happens mostly after repeated pregnancy, caesarean surgery and excessive abdominal obesity. It is a form of pseudohernia where the bulge is covered by fascial layers. It is repaired using a conventional abdominoplasty approach along with Tummy tuck in most circumstances.
How is the Surgery Performed for Abdominal Wall Hernia?
The surgery is performed under general anesthesia or LA and IV sedation. Direct approach is used in small hernias such as umbilical and Incision hernia using old scars, whereas a lower abdominal approach is used for Diverification of Recti muscles. For details, refer to Endoscopic assisted muscle repair and Lipoabdominoplasty.
If the hernia is very large or recurrent reconstructive methods such as Rectus sheath reinforcement or flaps are used, in many cases, a nonabsorbable mesh is used to strengthen the abdominal fascia and muscles.
What is the Recovery Period After Surgery?
One or two days of hospital stay is required. Patients can be ambulated with an abdominal binder to support the abdomen as soon as possible after the surgery. Activities can be increased in 2-3 weeks time depending upon the healing process.
What are the Risks of Abdominal Hernia Surgery?
The risks include hematoma, infection, mesh extrusion, recurrence, scarring etc.