What are the risks of an untreated hernia. How can you identify different types of hernias. What treatment options are available for hernias. When should you seek immediate medical attention for a hernia. How can hernias be prevented.

Understanding Hernias: Types, Causes, and Symptoms

A hernia occurs when part of an organ or tissue protrudes through a weak spot in the surrounding muscle or connective tissue. While hernias can develop in various parts of the body, they most commonly occur in the abdominal area. Understanding the different types of hernias, their causes, and symptoms is crucial for early detection and proper treatment.

Common Types of Hernias

• Inguinal hernia
• Femoral hernia
• Umbilical hernia
• Incisional hernia
• Hiatal hernia

Inguinal hernias are the most prevalent type, particularly in men. They occur when abdominal contents, such as fat or intestinal tissue, push through a weak spot in the lower abdominal wall, often in the groin area. Femoral hernias, while less common, are more frequently seen in women and can be more dangerous due to the risk of strangulation.

Umbilical hernias are common in infants and young children, appearing as a bulge near the navel. Incisional hernias develop at the site of previous abdominal surgeries, where the surgical wound hasn’t fully healed. Hiatal hernias occur when part of the stomach pushes through the diaphragm into the chest cavity.

Causes and Risk Factors

Hernias can be congenital or acquired. Risk factors for developing a hernia include:

• Age-related muscle weakness
• Chronic coughing or sneezing
• Obesity
• Pregnancy
• Heavy lifting or straining
• Previous abdominal surgeries
• Family history of hernias

Understanding these risk factors can help individuals take preventive measures and seek medical attention when necessary.

Recognizing Hernia Symptoms

The most common sign of a hernia is a visible bulge or lump in the affected area. Other symptoms may include:

• Discomfort or pain, especially when coughing, lifting, or straining
• A feeling of heaviness or fullness in the abdomen
• Difficulty passing stool or gas
• Heartburn or acid reflux (in cases of hiatal hernia)

It’s important to note that some hernias may be asymptomatic, especially in their early stages. Regular check-ups and awareness of one’s body can aid in early detection.

The Phenomenon of Spontaneous Hernia Rupture

While rare, spontaneous rupture of a hernia can occur, particularly in cases of incisional hernias. This condition refers to the sudden breakdown of the hernia sac, leading to the exposure of abdominal contents. Understanding this phenomenon is crucial for recognizing potential emergencies and seeking timely medical intervention.

Factors Contributing to Spontaneous Rupture

Several factors can increase the risk of spontaneous hernia rupture:

• Large hernia size
• Longstanding, untreated hernias
• Increased intra-abdominal pressure
• Weakened abdominal wall tissues
• Trauma or sudden physical strain

Incisional hernias are particularly susceptible to spontaneous rupture due to the inherent weakness of the surgical site and the potential for inadequate healing.

Signs and Symptoms of Hernia Rupture

Recognizing the signs of a ruptured hernia is crucial for prompt medical attention. Symptoms may include:

• Sudden, severe pain at the hernia site
• Rapid increase in hernia size
• Skin discoloration or bruising over the hernia
• Nausea and vomiting
• Fever and signs of infection

Any sudden change in the appearance or symptoms of a hernia should be evaluated by a medical professional immediately.

Diagnosing Hernias: From Physical Examination to Advanced Imaging

Accurate diagnosis of hernias is essential for proper treatment and prevention of complications. While many hernias can be diagnosed through a physical examination, some cases may require advanced imaging techniques for confirmation and detailed assessment.

Physical Examination

A healthcare provider typically begins the diagnostic process with a thorough physical examination. This may involve:

• Visual inspection of the affected area
• Palpation to feel for any abnormal bulges or masses
• Asking the patient to cough or strain to make the hernia more visible
• Assessing for tenderness or pain in the area

In many cases, a skilled physician can diagnose a hernia based on these physical findings alone.

Advanced Imaging Techniques

When physical examination results are inconclusive or more detailed information is needed, imaging studies may be employed:

• Ultrasound: A non-invasive, radiation-free method that can visualize soft tissues and detect hernias
• Computed Tomography (CT) scan: Provides detailed cross-sectional images of the abdominal area
• Magnetic Resonance Imaging (MRI): Offers high-resolution images without radiation exposure

These imaging techniques can help determine the exact location, size, and contents of a hernia, as well as identify any potential complications.

Treatment Options: From Watchful Waiting to Surgical Intervention

The management of hernias varies depending on the type, size, location, and associated symptoms. Treatment options range from conservative approaches to surgical repair.

Conservative Management

For small, asymptomatic hernias, a “watchful waiting” approach may be recommended. This involves:

• Regular monitoring of the hernia’s size and symptoms
• Lifestyle modifications to reduce strain on the affected area
• Use of supportive devices like trusses or binders

However, it’s important to note that many hernias will eventually require surgical intervention as they tend to enlarge over time.

Surgical Repair

Surgical repair is the definitive treatment for most hernias. The two main approaches are:

1. Open hernia repair: Involves making an incision over the hernia site to push the protruding tissue back into place and reinforce the weakened area with mesh or sutures.
2. Laparoscopic hernia repair: A minimally invasive technique using small incisions and specialized instruments to repair the hernia from inside the abdominal cavity.

The choice between these methods depends on factors such as hernia size, location, and the patient’s overall health status.

Recovery and Follow-up

Post-operative care is crucial for successful hernia repair. This typically involves:

• Pain management
• Gradual return to normal activities
• Follow-up appointments to monitor healing
• Long-term lifestyle modifications to prevent recurrence

Patients should be aware of potential complications and report any unusual symptoms promptly.

Complications of Untreated Hernias: When to Seek Immediate Medical Attention

While some hernias may remain asymptomatic for extended periods, others can lead to serious complications if left untreated. Understanding these potential risks is crucial for recognizing when immediate medical intervention is necessary.

Incarceration and Strangulation

Two of the most severe complications of untreated hernias are incarceration and strangulation:

• Incarceration occurs when the herniated tissue becomes trapped and cannot be pushed back into its original position.
• Strangulation happens when the blood supply to the incarcerated tissue is cut off, leading to tissue death.

These conditions are medical emergencies requiring immediate surgical intervention to prevent life-threatening complications.

Signs of Hernia Complications

Recognizing the signs of hernia complications is crucial for timely medical intervention. Seek immediate medical attention if you experience:

• Sudden, severe pain or tenderness at the hernia site
• Rapid swelling or enlargement of the hernia
• Nausea, vomiting, or inability to pass gas or stool
• Fever or signs of infection
• Discoloration or redness of the skin over the hernia

Prompt recognition and treatment of these symptoms can prevent serious, potentially life-threatening outcomes.

Preventing Hernias: Lifestyle Modifications and Risk Reduction Strategies

While not all hernias can be prevented, certain lifestyle modifications and risk reduction strategies can significantly lower the likelihood of developing a hernia or experiencing complications from an existing one.

Maintaining a Healthy Weight

Obesity is a significant risk factor for hernia development and recurrence. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce abdominal pressure and strengthen supporting muscles.

Proper Lifting Techniques

Using correct lifting techniques is crucial for preventing hernias, especially for those whose occupations or hobbies involve heavy lifting. Key points include:

• Bending at the knees, not the waist
• Keeping the back straight
• Avoiding twisting while lifting
• Using leg muscles to lift, not the back

Managing Chronic Conditions

Certain chronic conditions can increase the risk of hernia development. Proper management of these conditions is essential:

• Treating chronic cough
• Managing constipation
• Controlling conditions that cause frequent vomiting

Strengthening Core Muscles

Regular exercise focusing on core strength can help support the abdominal wall and reduce the risk of hernia formation. Exercises may include:

• Planks
• Abdominal crunches
• Pelvic tilts
• Yoga or Pilates

It’s important to consult with a healthcare provider before starting any new exercise regimen, especially if you have a pre-existing hernia or other health conditions.

Living with a Hernia: Quality of Life and Long-term Management

For individuals diagnosed with a hernia, understanding how to manage the condition and maintain a good quality of life is essential. While some hernias may require immediate surgical intervention, others can be managed conservatively for extended periods.

Monitoring and Self-care

Regular monitoring of the hernia is crucial for those opting for conservative management. This includes:

• Tracking changes in size or appearance of the hernia
• Noting any new or worsening symptoms
• Avoiding activities that exacerbate symptoms
• Using supportive devices as recommended by healthcare providers

Adapting Daily Activities

Living with a hernia may require some lifestyle adjustments to prevent exacerbation of symptoms:

• Modifying exercise routines to avoid strain on the affected area
• Using assistive devices for heavy lifting or strenuous tasks
• Wearing comfortable, non-restrictive clothing
• Managing diet to prevent constipation and reduce abdominal pressure

Emotional and Psychological Support

Coping with a chronic condition like a hernia can have psychological impacts. Seeking support through:

• Support groups for individuals with hernias
• Counseling or therapy to address anxiety or body image concerns
• Open communication with healthcare providers about concerns and quality of life issues

can be beneficial for overall well-being and management of the condition.

Planning for the Future

While some hernias can be managed conservatively for extended periods, it’s important to have a long-term plan in place. This may include:

• Regular check-ups with healthcare providers
• Discussing potential surgical options and timing
• Preparing for possible emergencies or complications
• Staying informed about new treatment options and advancements in hernia care

By taking a proactive approach to hernia management, individuals can maintain a good quality of life and be prepared for future treatment needs.

Visual Guide To Hernias

Medically Reviewed by Melinda Ratini, MS, DO on March 09, 2021

Even if you don’t have six-pack abs, your belly still has walls of muscle that support you, help you move, and hold things in place inside you. A hernia happens when part of your body squeezes through a weak spot or opening in a muscle wall. It’s like an inner tube bulging through a hole in a worn-out tire. You can get different kinds of hernias, but most of them happen somewhere between your hips and chest.

Typically, hernias don’t hurt — you see a bulge or lump in your belly or groin. Sometimes, you only see the bulge when you laugh, cough, or strain, like when you lift a heavy object. Often, you can press it back into place. You may also notice:

• The bulge gets bigger over time.
• You have a feeling of fullness.
• Pain, pressure, or a dull ache around the bulge
• Pain when you lift something

This is the most common kind of hernia. It happens most often in men, but women sometimes get them during pregnancy. It’s when fat or a loop of intestine pushes into your groin through a weakness in your lower belly. You may be born with it, or the problem can come with:

• Age, as muscles shrink over time
• Chronic coughing, as with someone who smokes
• Strain from physical activity or going to the bathroom

These are like inguinal hernias, but in a different part of the groin. Women are more likely to get them. They’re not common, but they can be dangerous — you may not notice any symptoms unless a muscle squeezes the hole shut while the intestine is poking through (called strangulation). In that case, the lump will be hard and tender and you might have severe belly pain, nausea, or vomiting. If you have these symptoms, get medical help right away.

You get these hernias between your belly button and chest when some tissue or intestine pops through your belly’s muscles. You may be more likely to get one if you:

• Are very overweight
• Have a cough that doesn’t go away
• Lift heavy objects, like with construction work
• Strain hard when you go the bathroom
• Throw up often

Incisional hernias are fairly common for people who’ve had surgery on their bellies. They happen when tissue squeezes through the surgery wound before it totally heals. You’re more likely to get one if you run into problems as you heal, like an infection. The only way to fix them is with another surgery, but they’re often hard to treat.

With this kind of hernia, part of your stomach pops through your diaphragm and into your chest. (Your diaphragm is a sheet of muscle between your belly and chest.) You won’t see a bulge, but you might get heartburn, chest pain, and a sour taste in your mouth. People 50 and older and pregnant women are more likely to have them. Pregnancy can put pressure on the belly and weaken its muscles. They’re typically treated with medication and lifestyle changes, like having several smaller meals rather than three large ones or not lying down within 3 hours of eating.

When kids get hernias, they’re typically inguinal or umbilical hernias. Inguinal hernias are most common in babies born early and in boys born with a testicle that hasn’t dropped into the scrotum. Umbilical hernias happen right around the belly button. They don’t usually hurt and may just look like an outie belly button. They often go back into place on their own by age 2.

While a hernia may start out as a harmless bulge, it can get bigger and start to hurt. In some cases, it can even be life-threatening. So even if it doesn’t seem like a big deal, it’s best to see your doctor if you have symptoms of a hernia, like a lump or bulge you can’t explain.

If a loop of intestine gets trapped in a hernia, you have a serious problem called incarceration. It blocks the flow of waste through your body. If it’s trapped tightly, the intestine’s blood flow can get cut off. Get help right away if you have a hernia and these symptoms:

• Bulge is dark, purple, or red.
• You can’t pass gas or poop.
• You have a fever.
• Pain that quickly gets worse.
• You’re throwing up or have an upset stomach.

Most of the time, your doctor can tell you have a hernia with just a physical exam. They may ask you to stand and cough to make the hernia easier to see, but that’s usually it. If your doctor’s not totally sure, you might have some imaging tests to get a better look. These might include:

• Ultrasound: High-frequency sound waves make an image of your internal organs.
• Computerized tomography (CT): X-rays are taken at different angles and put together to make a more complete picture.
• Magnetic resonance imaging (MRI): This uses a powerful magnet and radio waves to get a detailed view.

You don’t always need to treat hernias. Umbilical hernias in kids may heal on their own, so your doctor may suggest you wait until around age 4 for treatment. For adults, especially if surgery could be risky for you, your doctor may suggest just keeping an eye on it as long as the hernia’s small and not causing any major problems for you.

The most common treatment for any hernia is surgery to put in a mesh that helps support the wall around your belly. You may have open surgery, where your doctor makes a long opening in your skin, or you may get laparoscopic surgery, which uses a few smaller openings. You may heal quicker from laparoscopic surgery, but some studies show the hernia may be a little more likely to come back.

Not really. This cloth device that’s worn like a binder around your middle or like underwear won’t make you better. You may get one to wear for a short while after surgery — it may make you more comfortable — but that’s likely the only time your doctor will suggest it. The same goes for tape, bandages, and anything else to hold a hernia in place — they won’t heal the hernia or prevent more serious problems.

You can lower your odds of getting a hernia if you:

• Talk to your doctor if you have a cough or sneezing that won’t go away. Quitting smoking helps.
• Eat fruits, veggies, and whole grains to keep yourself regular. 
• Stay at a healthy weight with diet and exercise.
• Use good form when you do physical activity. For example, when lifting a heavy object, bend from your knees instead of your waist.

IMAGES PROVIDED BY:

1) Science Picture Co / Science Source

2) Dr P. Marazzi / Science Source

3) Science Picture Co / Science Source

4) F. D. Giddings / Medical Images

5) Science Picture Co / Science Source

6) BIOPHOTO ASSOCIATES / Getty Images

7) Keith A Pavlik / Medical Images

8) RUTH JENKINSON / Medical Images

9) JackF / Getty Images

10) Sandra Nicol / iStock Photos

11) Westend61 / Getty Images

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13) PhotoGraphyKM / Getty Images

14) Wikivisual / Creative Commons

15) angelhell / Getty Images

SOURCES:

NHS: “Umbilical Hernia Repair,” “Hernia,” “Inguinal Hernia Repair,” “Hiatus Hernia,” ”Femoral Hernia Repair.”

Cleveland Clinic: “Hernia,” “Hiatal Hernia.”

Columbia University, Department of Surgery: “Hernia.”

Merck Manual: “Abdominal Wall Hernias. ”

Mayo Clinic: “Inguinal Hernia.”

Johns Hopkins Medicine, Webcast: “Hernia Treatment,” ”Comprehensive Hernia Center.”

Dartmouth-Hitchcock Medical Center: “Ventral Hernia.”

Mt. Sinai Beth Israel: “Hernia Types.”

The British Hernia Center: “Hernia Overview.”

KidsHealth, For Teens: “Hernias,” For Parents: “Hernias.”

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Inguinal Hernia | Johns Hopkins Medicine

An inguinal hernia is a bulge that occurs in your groin region, the
area between the lower part of your abdomen and your thigh. Inguinal
hernias occur because of a weakening of the muscles in the lower
abdomen.

Three layers protect the intestines inside the lower abdomen. The first
is a thin membrane called the peritoneum. The second is made up of the
abdominal muscles, and the third is your skin.

An inguinal hernia forms when your intestines and the peritoneum push
through the muscles and appear as a bulge under your skin. Inguinal
hernias are dangerous because they tend to keep getting larger and your
intestine can get trapped inside the bulge and lose its blood supply.
This is called a strangulated inguinal hernia, and surgery may be
needed to correct the problem.

Facts about inguinal hernia

Inguinal hernias may occur on one or both sides of the body and are
much more common in men than women. An inguinal hernia can appear at
any age. Infants may be born with one that doesn’t show up until they
become adults. About five out of every 100 children are born with the
condition.

An inguinal hernia can also develop over time if you increase pressure
on the walls of your abdominal muscles through activities like
straining to go to the bathroom, coughing over a long period, being
overweight, or lifting heavy weights. If you have a family history of
inguinal hernia, you may be at a higher risk for one. Infants born
before their due date are also at higher risk.

Types of inguinal hernia

Inguinal hernias come in two types:

• Indirect inguinal hernia.
  This is the most common type, and a type of hernia that you may
  be born with. Although it can occur in men and women, it is
  much more common in men. This is because the male testicle
  starts inside the abdomen and has to go down through an opening
  in the groin area to reach the scrotum (the sac that holds the
  testicles). If this opening does not close at birth, a hernia
  develops. In women, this type of hernia can occur if
  reproductive organs or the small intestine slides into the
  groin area because of a weakness in the abdominal muscles.

• Direct inguinal hernia.
  This type of hernia is caused by weakening of your abdominal
  muscles over time and is more likely to be seen in adults.
  Direct inguinal hernias occur only in men.

Symptoms

The main symptom is a visible bulge in your groin area. In men, an
inguinal hernia may extend down into the scrotum and cause an enlarged
scrotum. Small hernias may slide back and forth through the opening in
the abdomen and not cause any symptoms. Larger hernias may be massaged
back into the abdomen. Symptoms of hernias that go back and forth
include:

• A bulge that increases in size when you strain and disappears
  when you lie down

• Sudden pain in your groin or scrotum when exercising or
  straining

• A feeling of weakness, pressure, burning, or aching in your
  groin or scrotum

An inguinal hernia that can’t be moved back into the abdomen is called
an incarcerated hernia. This is a dangerous situation because the part
of your intestine inside the hernia can become strangulated, which is a
medical emergency. Symptoms of a strangulated inguinal hernia include:

Diagnosis

Inguinal hernia is most often diagnosed through a medical history and
physical examination. Your doctor will ask you questions about hernia
symptoms. During the exam, he or she will look for and feel for a bulge
in your groin or scrotal area. You may be asked to stand and cough to
make the hernia appear. Inguinal hernias in children may only be seen
or felt when the child cries.

Inguinal Hernias in Children | Q&A with Dr. Clint Cappiello

Treatment

The way to repair an inguinal hernia is usually with a surgical
procedure. In adults with small hernias that don’t cause symptoms,
treatment may only be to watch it. Adults with symptoms and most
children usually have surgery to prevent the possible complication of a
strangulated hernia in the future. An incarcerated or strangulated
hernia may need emergency surgery.

There are two main types of surgery for inguinal hernia:

• Open repair.
  An incision is made through the skin in the groin area. The
  surgeon moves the hernia back inside the abdomen and closes the
  abdominal wall with stitches. Mesh placement may be used to strengthen the closure and reduce the risk of recurrence of the hernia.   

• Laparoscopy or robotic-assisted repair.
  This type of surgery uses a few small incisions and a thin
  scope with a tiny camera. The surgeon works through the scope
  to repair the hernia, sometimes operating from a console maneuvering robotic arms. Mesh is typically used for these repairs. Recovery is shorter and pain is less severe after these minimally invasive approaches than with open repair.

Prevention

There is nothing you can do to prevent an indirect inguinal hernia, the
type you are born with. Direct hernias that occur over time may be
prevented with these precautions:

• Learn how to lift heavy objects properly.

• Avoid and, when needed, treat constipation to prevent straining
  when having a bowel movement.

• Get treatment for any persistent cough.

• If you are a man with an enlarged prostate and you strain to
  pass urine, get treated.

• If you are overweight, lose the extra pounds.

Managing inguinal hernia

If you have had surgery for inguinal hernia, it is important to follow
all your doctor’s instructions and keep your follow-up appointments.
Getting out of bed and walking is an important part of recovery and
helps prevent complications. You can help to keep an inguinal hernia
from coming back after surgery by avoiding heavy lifting and other
strenuous activity. Ask your doctor what types of activities are safe
and when you can return to work.

If you have a small hernia that is being watched or a repaired hernia,
take steps to avoid becoming constipated. Eat lots of fiber, drink
plenty of fluids, exercise, and go to the bathroom when you feel the
urge.

Call your doctor if your inguinal hernia symptoms get worse, and always
call right away if:

• You have a painful bulge that can’t be pushed back inside.

• You have increasing pain, swelling, or redness.

• You have nausea, fever, or vomiting along with hernia pain.

All about hernias

go back to the outpatient surgery department

ALL ABOUT HERNIAS

What is “hernia”?
A hernia is a protrusion of the abdominal organs under the skin through weak points in the abdominal wall. The outgoing organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). In the hernial sac, there can be almost any organ of the abdominal cavity (intestinal loops, bladder, less often – the stomach or part of it), the omentum, extremely rarely – the liver, spleen.

Fig. Incisional ventral hernia

Why does a hernia occur?
The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is to hold the internal organs in a natural position and counteract the intra-abdominal pressure they create. Under the action of intra-abdominal pressure, a defect (hernial orifice) can form in the weakest places of the abdominal wall, through which a hernia emerges. Predisposing factors may contribute to this, such as:

• Increasing intra-abdominal pressure

1. excessive exercise

2. severe cough, including chronic (smoker’s cough)

3. constipation

900 02 4. diseases in which shortness of breath develops with difficulty exhaling (bronchial asthma)

• Conditions and diseases associated with the development of weakness of the connective tissue (obesity, varicose veins of the legs, congenital pathologies of the connective tissue, hereditary predisposition)
• Patients previously operated on for hernias are also at risk for predisposing factors
• A hernia may go unnoticed or be accompanied by intense pain. In the future, under the influence of the same factors, a gradual increase in hernia occurs, up to the exit of most of the abdominal organs into the hernial sac.

Who can get a hernia?
Any person can develop a hernia, regardless of gender or age.
External signs and symptoms.
The appearance and symptoms of hernias may develop gradually or occur over a short period of time.

• Feeling of pressure, weakness or pain in the abdomen, groin or scrotum, arising or aggravated by exertion, straining.
• Visually defined “bulging”, bulge on the abdomen, in the inguinal region, scrotum, appearing or increasing in size during physical exertion, straining. Also, in the area of ​​the above formations, a feeling of discomfort or pain may appear during physical exertion, coughing, straining.

If you have any of the above symptoms, you should consult your doctor. The sooner the diagnosis is made and treatment is carried out, the higher the chance of preventing the development of complications, sometimes fatal.

Learn more about hernia types.

Fig. Classification of hernias of the anterior abdominal wall

Lumbar hernias of the anterior abdominal wall walls . The main anatomical formations through which lumbar hernial formations arise are the Petit triangle (Petit) and the Greenfelt-Lesgaft gap, aponeurotic fissures.
Petit’s triangle is limited behind by the outer edge of the broad back muscle, in front by the inner edge of the external oblique muscle, from below by the iliac crest. In the region of the Petit triangle, under the superficial fascia and thin aponeurosis, there is an internal oblique muscle.
Greenfelt-Lesgaft interval often has a quadrangular shape. Its upper border is formed by the lower serratus posterior muscle and the XII rib, medially it is delimited by the longitudinal muscles of the spine, the square muscle of the lower back, and the edge of the internal oblique muscle runs in front and below. The shape and size of the gap can vary depending on the length of the XII rib – with a long rib, the Greenfelt-Lesgaft gap is sometimes absent or looks like a gap, and with a short rib it increases in size.
Aponeurotic fissures usually form at the site of passage of vessels and nerves, but can sometimes appear as a result of rupture or maldevelopment of the aponeurosis. Among the causal factors contributing to the occurrence of hernial formation in these areas is the weakness of the connective tissue and muscle atrophy, inflammatory processes. Hernial protrusions are more common on the left than on the right, bilateral are rare.

Recurrent hernias
They are a complication of surgical treatment of hernias.
The causes of recurrence of hernial protrusion may be associated with the patient’s lifestyle and structural features of his body.

For example: non-compliance with the terms of the recovery period, when a person begins active physical activity ahead of time.
With age-related changes and a number of pathological conditions, when tissues can become flabby, change elasticity and structure, which also affects the quality and duration of healing after the operation. So in elderly, malnourished or very obese patients, relapses can be observed regardless of the method of operation and the course of the postoperative period
Main causes of recurrent hernias:

• errors related to surgical technique
• connective tissue deficiency
• wound infection during or after surgery
• excessive physical exertion, especially shortly after surgery

The only treatment for recurrent hernias is surgery. At the same time, various methods of hernioplasty are selected using various mesh prostheses.

Fig. Removal of old and deformed graft

Fig. Restoration of the integrity of the inguinal canal and reprosthetic hernioplasty according to Liechtenstein

Why is a hernia dangerous?
In addition to the obvious inconvenience associated with the presence of a cosmetic defect, reduced physical activity and ability to work, a hernia carries the risk of developing a number of complications. These include violations of the functions of organs located in the hernial sac – constipation, urination disorders, with the release of large volumes of organs from the abdominal cavity – respiratory disorders. A formidable complication is the development of hernia incarceration.
Infringement – compression of the hernia in the hernial orifice, resulting in the development of necrosis of the contents of the hernial sac. The infringement is accompanied by a sharp pain in the area of ​​the hernial protrusion. The most dangerous in case of infringement is the development of intestinal obstruction (the loop of the intestine is infringed) and the peritonitis that follows it. This situation requires immediate resolution through surgery. By and large, regardless of which organ is the contents of the hernial sac, the end result without appropriate treatment is one – peritonitis, the difference is only in time. Peritonitis – inflammation of the peritoneum – a formidable complication of a large number of diseases, including strangulated hernias, the development of this pathological condition is one of the most difficult problems in surgery. Age, obesity, the presence of concomitant pathology further exacerbate this situation. Without surgery, the only outcome is death. Even if the operation is performed, but more than a day has passed since the infringement began, up to 30% of patients die in the postoperative period. No need to bring such a small problem as a hernia to such a tragic situation.

How is a hernia treated?
The only way to treat a hernia in adult patients is to perform an operation (hernia repair).

When should a hernia be treated?
Following from the above, the earlier the operation is done, the better.

Is it possible to do without surgery?
-No.
For adult patients with a hernia, the only treatment is surgery.

Are there any contraindications for surgery?
Herniotomy should not be performed in the presence of severe concomitant pathology, when the operation can only harm, not help. Such cases include: the coming months after myocardial infarction, stroke, a number of other extremely severe comorbidities. It should be remembered that the presence of chronic diseases is not an absolute contraindication to the operation, but only requires appropriate correction in the preoperative period.

Can other surgeries be performed at the same time as hernia surgery?
Yes. An operation for a hernia can be supplemented by almost any surgical intervention.
Often, especially in older patients, there are several problems that require surgical intervention. In such situations, it is preferable to get by with one operation that combines the removal of a hernia and some other problem. The implementation of combined operations is a priority method, as it allows solving two (or more) problems in one surgical intervention, relieves the patient of psycho-emotional problems associated with the need to undergo several operations.

What types of operations are performed to repair a hernia?
To date, more than 300 methods of hernia repair are known – ventral, inguinal, umbilical, femoral, postoperative. But all of them can be fundamentally divided into two groups:

• with plasty with own tissues – tissues of the abdominal wall around it are used to close the hernia opening
• with plasty with synthetic materials (or “tension-free” plasty) – synthetic prostheses made of surgical threads are used to close the hernial opening.

Plastic surgery with own tissues is the oldest group of methods, born in the second half of the 19th century, it is the most extensive and widespread. Its essence is the closure of the hernial ring with the patient’s own tissues (muscles, fascia and aponeuroses) in one way or another. The frequency of hernia recurrence after these operations varies from 20% to 70% depending on the condition of the patient’s tissues, the method of hernioplasty and the correctness of its choice. The main disadvantages are a pronounced pain syndrome for the first days after surgery due to tissue tension and long periods of physical rehabilitation. Intensive physical labor is contraindicated for at least 3 months after surgery.

Tension-free plasty methods for the patient’s own tissues have existed since the second half of the 1960s. They are distinguished from methods of plasty with their own tissues by the use of “patches” made of synthetic materials to close the hernial orifice. In recent years, these methods have gained great popularity, which became possible due to the creation of perfect synthetic materials and the development of new methods for closing the hernia orifices, which practically guarantee the patient from the occurrence of hernia recurrence. The recurrence rate does not exceed 1% in specialized clinics, regardless of the type of hernia. Despite the skin incision over the hernia, pain after surgery is minimal, because. there is no tension on one’s own tissues. Intensive physical labor is possible a month after the operation, household physical activity is not limited. This allows such operations to be performed on an outpatient basis. A positive point is also the possibility of performing the operation under local or spinal anesthesia, which is especially important for the elderly and patients with heart and lung diseases. Due to its reliability and simplicity, hernioplasty according to the I.L. Lichtenstein method – for inguinal hernias – has received the greatest prevalence. It is applicable for any type and size of inguinal hernias.

Fig. Plastic surgery of the inguinal canal with a mesh polypropylene prosthesis according to Liechtenstein .

Laparoscopic (through punctures of the anterior abdominal wall) methods of hernia repair should also be mentioned. These are operations that are performed under the control of a laparoscope – a device that allows using a mini-video camera to eliminate a hernia from the abdominal cavity without cutting the skin over the hernia. They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis. The frequency of hernia recurrence after this repair is 2-5%, which is determined by the type of hernia and the preparedness of surgeons. Important advantages of these methods are low invasiveness, which means a slight pain syndrome after surgery, short rehabilitation periods (up to a month with physical labor), as well as the possibility of performing bilateral plastics and, if necessary, combined operations in the abdominal cavity through the same punctures of the abdominal wall. Serious disadvantages of this group of methods include the need for general anesthesia (anesthesia), the need to inject gas into the abdominal cavity to create an operative space (dangerous in patients with lung and heart diseases).

how far can I travel with her? — magazine Behind the wheel

With each generation, the wheels of cars are getting bigger – a low profile is not uncommon even on inexpensive models. The chances of damaging such tires are higher. Since motorists have no more money, it is tempting to put off replacing a tire until better times, even if a hernia has formed on it. You don’t need to do that.

Low profile tires are beautiful. But not for our roads! Even in Moscow, for the “summer” you want to change your shoes not according to the weather, but after the road builders patch up the traditional spring pits. There are two inconveniences for the owner from this: bent wheels and hernias on tires.

What is a herniated tire?

The tread is not worn, but the tire needs to be replaced … How so?

Hernias sometimes occur right on the tread. You can’t ride with such a wheel: when driving, it gives off to the steering wheel as if the wheel was assembled without balancing. But lateral hernias are often ignored, because they “sort of” do not affect driving properties. Even balancing subjectively remains normal. We assure you: you should not ignore such a defect on rubber, even if it is still small.

A hernia appears as a bulge on the splint. This is a consequence of damage to the inner layer that ensures the integrity of the tire – the cord. Any slack in it under the influence of internal pressure in the inflated wheel will turn into a “bump”. It can suddenly become large, palpable in motion and clearly visible. But more often swelling starts with a small diameter. And here are the options. It happens that it does not grow, and other drivers happily drive with this until the tire is completely worn out.

Why does a tire herniate?

If I change wheels, do I need to balance them every season?

The cause of hernias can be a factory defect or external influence – a blow from a pothole at speed, from a curb during an unsuccessful parking, from another car during an accident. In the first case, the guarantee that many tire brands now provide will help. Moreover, in this scenario, the defect is likely to manifest itself in the first weeks of operation. The rest will have to solve the problem on their own. More often, “bumps” pop up on the front wheels, which get more than the rear ones. After all, the front of the car, as a rule, is loaded more heavily.

If the hernia is large enough, it will cause a thump while riding and become difficult to ignore. A slight bulge that seems safe to the driver, however, leads to overheating of the rubber and increased pressure on its individual sections. We think there is no need to explain that the discrepancy between the actual operating conditions and the calculated ones is not good?

What are the dangers of driving with a herniated tire?

The potential danger is that the tire may suddenly lose its tightness and pressure. If this happens to the front wheel, not every motorist will be able to maintain control of the car. Especially dangerous in the presence of a hernia is driving at high speeds, sudden starts and braking, heavy loading of the car (when the car’s weight is close to the maximum allowable or exceeding it), repeated wheel strikes on the road roughness, like those that previously led to the manifestation of a defect. In other words, the risk exists literally in every trip.

Critical tire wear: when we risk crossing the line

The verdict of professionals is unequivocal: it is impossible to drive with a bump. Ideally, you should immediately replace the wheel with a spare tire. There, in the trunk, a tire with a hernia often remains with drivers for months, or even years. They are guided by the fact that the fifth wheel is rarely required and there is no danger. Although, in a good way, the spare wheel should be kept in perfect condition: you never know in what situation and for how many kilometers it will be needed.

If there is no spare tire, but you need to drive, you can reduce the pressure in the wheel with a hernia, drive more slowly, avoid sudden maneuvers. A defective front wheel should be rearranged to the rear axle. If a wheel on the rear axle suddenly loses pressure, it’s still easier to keep control of the car. On a long journey, it is useful to periodically stop and check the condition of the problem tire.

Can a herniated tire be repaired?

Tires by size: why pay more for a low profile?

The possibility of repair depends on the nature of the damage.