A hernia is an abnormal protrusion of tissue. It occurs most commonly through the abdominal wall. Hernias often develop in the male groin, or inguinal region; into the upper thigh through the femoral canal; or through weaknesses arising from the incisions of previous surgery. They may occur in the upper midline of the abdominal wall (Epigastric hernias), around the umbilicus (umbilical hernias), or in less common sites (lumbar, pararectal hernias).

Epigastric hernia
This is usually a tiny but tender defect in the midline between the abdominal wall muscles. It contains a knuckle of fatty tissue from the inside. It is easily repaired using either a local or general anaesthetic.

Umbilical Hernia
These hernias are common. They are usually small defects beneath and around the umbilicus, containing fat from the abdomen. The defects are occasionally much larger, and can contain bowel with the fat.

They are easily repaired using either a local or general anaesthetic. Some larger hernias may need a non-absorbable plastic mesh to reinforce the defect.

Inguinal Hernias
Inguinal hernias are much commoner in men than in women. They arise in and around the weakness where the spermatic cord passes through the lower abdominal wall to the scrotum. They are an inevitable consequence of manís upright posture. According to their precise relationship to the cord and to the blood vessels of the abdominal wall, they may be described as direct or indirect. Indirect hernias may extend all the way into the scrotum, in which case they are known as inguinoscrotal hernias.

Inguinal hernias can be apparent at birth or appear during childhood. Technical and consent issues are discussed on the inguinal hernia page (link)

Femoral Hernias
Femoral hernias emerge into the upper inner thigh through the femoral canal. They are much commoner in older ladies. They may contain fat, or they may present as an emergency with a knuckle of bowel trapped within.

Uncomplicated femoral hernias are easily repaired in the groin using either a local or general anaesthetic. Rarely, trapped bowel may require a formal exploration of the abdominal cavity to resolve.

Incisional Hernias

These can range from small defects in small abdominal surgical scars, to huge defects in full length abdominal scars where the entire would and abdominal wall has lost strength and normal structure.

Some incisional hernias are easily repaired using either a local or general anaesthetic, either with or without a synthetic non-absorbable mesh. Others may be so large as to beyond practical surgical reconstruction.

Large incisional hernias, while unsightly and distressing, are very rarely at risk of complications such as bowel obstruction and strangulation. They are often best managed by non-operative means, such as by using good elasticated support and control underwear.

Hiatus Hernias

A hiatus hernia is an internal weakness in the diaphragm between the chest and the abdomen, through which the upper stomach can prolapse to varying degrees. This can cause severe heartburn and mechanical problems with digestion.

The symptoms of hiatus hernias can either be treated medically with antacids, or surgically, using either an open or a laparoscopic approach to repair the diaphragmatic weakness and to reduce the likelihood of acid reflux from the stomach into the oesophagus (gullet).

Hiatus hernia surgery is the province of the specialist upper gastrointestinal surgeon.

Text provided by Mr David Rew, Copyright 2003

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