Home | Venous Surgery | Carotid Surgery | Aneurysm Surgery | | Sympathectomy | Vascular Reconstructions | General Surgery | Hernia Surgery ABDOMINAL WALL HERNIAS Hernias represent a tear in the muscles of the abdominal wall through which the abdominal contents e.g. bowel, omentum, may protrude and come to lie underneath the skin. Certain parts of the abdominal wall are weak spots and hernias are more common at these sites - the commonest being the groin especially in men. The groin is a particular weak spot in men because this represents a natural gap where the blood vessels and spermatic cord penetrate the muscles to reach the testicles. Straining associated with coughing and lifting may stretch this natural gap enough to form an hernia - an inguinal hernia. This is also a weak spot in women because a structure known as the round ligament passes through the gap instead of the spermatic cord. Other weak spots include around the umbilicus (umbilical hernia), inside of the top of the thigh (femoral hernia) and any point along the midline of the abdomen (epigastric or ventral hernia). Hernias in other sites can also occur. In the early stages, there may be no lump to feel but people describe pain or a sense of weakness especially if lifting or straining. As the hernia enlarges, a lump becomes obvious which appears on standing but either disappears on lying down or can be ''pushed back' inside - this is known as a reducible hernia. Typically the lump appears on coughing. Later the hernia may become larger and is present most of the time. It may become more difficult to 'reduce' i.e. push back inside. Once a hernia is present it is unlikely to get better on it's own and will usually enlarge. However the main risk with hernias is strangulation. Strangulation occurs when a loop of bowel or other abdominal organ enters a hernia and becomes stuck. This may occur suddenly during a period of exertion or straining. Within a few hours the bowel within the hernia begins to swell and eventually the blood supply to the bowel is cut off and the bowel dies and perforates resulting in peritonitis. This represents a surgical emergency and requires an urgent, life-saving operation. It is impossible to predict with any certainty which hernias will strangulate so , for safety, most hernias are repaired sooner rather than later. TREATMENT FOR HERNIAS Because of the risk of strangulation most hernias are treated surgically. For inguinal hernias an alternative treatment is a truss. To use a truss the hernia is pushed back inside, a pressure device is applied over the weak spot preventing the hernia from reappearing, and the pressure device is kept in place by a tight fitting garment or belt. It is possible to control hernias in this way but many people find a truss cumbersome and uncomfortable and their use is mainly reserved for patients unfit for surgery.