What are the differences between ventral and sports hernias. How are these conditions diagnosed and treated. Can you have a hernia without a visible lump. What causes ventral and sports hernias.

Understanding Ventral Hernias: Types and Causes

A ventral hernia occurs when intestine or other tissue protrudes through a weakness in the abdominal wall. Two common types are umbilical and incisional hernias. But what causes these abdominal wall weaknesses?

• Natural body formation
• Previous abdominal surgery
• Pregnancy
• Obesity
• Chronic coughing
• Heavy lifting

These factors can create or exacerbate gaps in the abdominal muscles, allowing tissue to push through. Understanding the root cause is crucial for preventing recurrence after treatment.

Recognizing Ventral Hernia Symptoms: Beyond the Visible Lump

Can you have a hernia without a visible lump? Yes, it’s possible. While a noticeable bulge is a common sign, other symptoms may indicate a ventral hernia:

• Abdominal pain or discomfort, especially around the affected area
• Constipation or changes in bowel habits
• Nausea and vomiting
• Fever (in cases of complications)
• Rapid heart rate

It’s important to note that some hernias may be asymptomatic or only become apparent during certain activities, such as coughing or straining.

Diagnosing Ventral Hernias: Medical Examination and Imaging Techniques

How do healthcare providers diagnose ventral hernias? The process typically involves:

1. Medical history review
2. Physical examination
3. Diagnostic imaging (if necessary)

During the physical exam, your doctor may ask you to stand and cough, which can make the hernia more pronounced. In some cases, additional tests may be required:

• Blood tests to check for infection
• Ultrasound, MRI, or CT scans to locate the hernia and assess its severity

These diagnostic tools help healthcare providers determine the best course of treatment and identify any potential complications.

Ventral Hernia Treatment Options: Surgical Approaches

What are the main treatment options for ventral hernias? Surgery is typically the recommended course of action. The three primary surgical approaches are:

1. Open Hernia Repair (Herniorrhaphy or Hernioplasty)

This traditional method involves making an incision over the hernia site, pushing the protruding tissue back into place, and repairing the abdominal wall. In some cases, synthetic mesh may be used to reinforce the repair.

2. Laparoscopic Repair

A minimally invasive technique using small incisions and a camera-guided system. The surgeon repairs the hernia using specialized instruments, often incorporating mesh for added strength.

3. Robotic-Assisted Repair

Similar to laparoscopy, but with the added precision of robotic arms controlled by the surgeon. This method allows for enhanced dexterity and visualization during the procedure.

The choice of surgical approach depends on factors such as hernia size, location, and the patient’s overall health.

Sports Hernias: A Misnomer in Athletic Injuries

Is a sports hernia actually a hernia? Despite its name, a sports hernia is not a true hernia. The correct term is athletic pubalgia. This condition involves torn tendons attaching to the pelvis, rather than a protrusion of abdominal contents.

Sports hernias typically affect athletes in high-intensity sports requiring rapid twisting movements, such as:

• Football
• Hockey
• Soccer
• Rugby
• Skiing
• Running
• Hurdling

The repetitive or explosive motions in these sports can strain and tear the soft tissues in the lower abdomen and pubic area.

Identifying Sports Hernias: Diagnostic Challenges and Approaches

How do healthcare providers diagnose sports hernias? The process can be challenging due to the similarity of symptoms with other conditions. Diagnostic steps typically include:

1. Detailed history of the injury mechanism
2. Physical examination
3. Range of motion and strength testing
4. Imaging studies (if necessary)

The physical exam is crucial to differentiate a sports hernia from a true hernia or other abdominal or groin injuries. Imaging techniques such as MRI may be used to visualize soft tissue damage and rule out other conditions.

Treatment Strategies for Sports Hernias: Conservative and Surgical Options

What are the treatment options for sports hernias? The approach can vary based on the severity of the injury and the individual’s needs:

Conservative Treatment

• Rest and activity modification
• Physical therapy to strengthen core and pelvic muscles
• Anti-inflammatory medications
• Corticosteroid injections (in some cases)

Surgical Intervention

If conservative measures fail, surgery may be recommended. Surgical options can include:

• Laparoscopic repair of torn tendons
• Reinforcement of the weakened abdominal wall
• Adductor tendon release (if necessary)

The goal of surgery is to repair the damaged tissues and restore function, allowing the athlete to return to their sport.

Preventing Hernias: Strategies for Abdominal Health

Can hernias be prevented? While not all hernias are avoidable, certain strategies can help reduce the risk:

• Maintaining a healthy weight
• Practicing proper lifting techniques
• Strengthening core muscles
• Avoiding smoking
• Managing chronic cough
• Treating constipation promptly

For athletes, proper training techniques and gradual intensity progression can help prevent sports hernias.

Living with Hernias: Management and Quality of Life

How does a hernia impact daily life? The effects can vary depending on the type and severity of the hernia:

Ventral Hernias

• May limit certain physical activities
• Can cause discomfort or pain, especially when straining
• May require lifestyle modifications to prevent worsening

Sports Hernias

• Can significantly impact athletic performance
• May cause chronic pain or discomfort
• Often require temporary cessation of sports activities

In both cases, proper management and timely treatment are crucial for maintaining quality of life and preventing complications.

Complications of Untreated Hernias: When to Seek Immediate Care

What are the potential risks of leaving a hernia untreated? While some hernias may remain stable, others can lead to serious complications:

Incarceration

This occurs when the herniated tissue becomes trapped and cannot be pushed back into place. Symptoms may include severe pain, nausea, and vomiting.

Strangulation

A medical emergency where the blood supply to the herniated tissue is cut off. This can lead to tissue death (necrosis) and requires immediate surgical intervention.

Signs that warrant immediate medical attention include:

• Sudden, severe pain
• Rapid heart rate
• Fever
• Redness or discoloration of the skin over the hernia
• Inability to pass gas or have a bowel movement

Prompt recognition and treatment of these complications can prevent life-threatening situations.

Advances in Hernia Treatment: Emerging Technologies and Techniques

How is hernia treatment evolving? Recent advancements are improving outcomes and patient experiences:

Robotic Surgery

Offering enhanced precision and visualization, robotic-assisted hernia repairs are becoming increasingly common. Benefits may include:

• Smaller incisions
• Reduced post-operative pain
• Faster recovery times

Biological Mesh Materials

New biocompatible meshes are being developed to reduce the risk of complications and improve long-term outcomes. These materials may offer:

• Better integration with the body’s tissues
• Reduced risk of infection
• Improved healing in complex cases

Non-Invasive Treatments

For certain types of hernias, particularly small umbilical hernias in children, watchful waiting or the use of special bandages may be recommended. This approach can sometimes allow the hernia to close on its own without surgery.

As research continues, we can expect further innovations in hernia treatment, potentially offering less invasive options and improved long-term results.

Recovery and Rehabilitation: Returning to Normal Activities

What does the recovery process look like after hernia treatment? The timeline and specifics can vary based on the type of hernia and treatment approach:

Ventral Hernia Repair

• Initial recovery: 1-2 weeks for minimally invasive procedures, 3-6 weeks for open surgery
• Gradual return to normal activities over 4-8 weeks
• Full recovery and return to strenuous activities: 6-12 weeks

Sports Hernia Treatment

• Conservative treatment: 4-6 weeks of rest and physical therapy
• Surgical repair: 6-12 weeks before returning to sports activities
• Ongoing rehabilitation to prevent recurrence

Regardless of the type of hernia, following post-treatment instructions is crucial for optimal recovery. This may include:

• Proper wound care
• Gradual increase in activity levels
• Core strengthening exercises
• Avoiding heavy lifting during the initial recovery period

Working closely with healthcare providers and physical therapists can ensure a safe and effective return to normal activities.

Hernia Recurrence: Risk Factors and Prevention Strategies

Can hernias come back after treatment? Unfortunately, hernia recurrence is possible. Understanding the risk factors and prevention strategies is key to long-term success:

Risk Factors for Recurrence

• Obesity
• Smoking
• Chronic cough
• Heavy lifting or strenuous activities
• Poor wound healing
• Certain medical conditions (e.g., connective tissue disorders)

Prevention Strategies

To minimize the risk of hernia recurrence, consider the following approaches:

• Maintain a healthy weight
• Quit smoking
• Develop proper lifting techniques
• Strengthen core muscles through targeted exercises
• Follow post-operative instructions carefully
• Address underlying health issues that may contribute to hernia formation

Regular follow-up with healthcare providers can help detect and address any potential issues early, reducing the risk of recurrence.

The Psychological Impact of Hernias: Addressing Mental Health Concerns

How do hernias affect mental health? While often overlooked, the psychological impact of hernias can be significant:

Common Psychological Challenges

• Anxiety about potential complications
• Depression related to activity limitations
• Body image concerns, especially with visible hernias
• Stress about surgical procedures and recovery
• Frustration with ongoing discomfort or pain

Coping Strategies

To address these mental health concerns, consider the following approaches:

• Open communication with healthcare providers about concerns and fears
• Joining support groups or online communities for individuals with hernias
• Practicing stress-reduction techniques such as mindfulness or meditation
• Seeking professional mental health support if needed
• Setting realistic expectations for recovery and celebrating small milestones

Addressing both the physical and emotional aspects of hernia management can lead to better overall outcomes and improved quality of life.

Hernia Research: Current Studies and Future Directions

What’s on the horizon for hernia treatment and prevention? Ongoing research is exploring various aspects of hernia care:

Current Research Focus Areas

• Development of advanced mesh materials with improved biocompatibility
• Investigation of genetic factors contributing to hernia formation
• Exploration of minimally invasive techniques for complex hernia repairs
• Studies on long-term outcomes of different surgical approaches
• Research into preventive strategies for high-risk individuals

Potential Future Developments

As research progresses, we may see advancements such as:

• Personalized treatment plans based on genetic profiles
• Tissue engineering approaches for hernia repair
• Enhanced imaging techniques for early detection and monitoring
• Novel non-surgical interventions for certain types of hernias

Staying informed about these developments can help patients and healthcare providers make more informed decisions about hernia management.

Hernia Care Across the Lifespan: Pediatric and Geriatric Considerations

How does hernia management differ for different age groups? Tailoring care to specific life stages is crucial for optimal outcomes:

Pediatric Hernias

• Often congenital in nature
• May resolve spontaneously in some cases
• Surgical repair techniques adapted for growing bodies
• Focus on minimizing long-term impact on development

Geriatric Hernias

• Higher risk of complications due to weakened tissues
• Consideration of overall health status in treatment decisions
• Potential need for less invasive treatment options
• Emphasis on maintaining quality of life and independence

Understanding these age-specific factors allows for more personalized and effective hernia care throughout a patient’s lifetime.

Ventral (Abdominal) Hernia | Johns Hopkins Medicine

What is a ventral hernia?

A ventral (abdominal) hernia refers to any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall. Umbilical and incisional hernias are specific types of ventral hernias.

Ventral Hernia Causes

The cause of a ventral hernia can differ depending on its location as well as your medical history, health and personal anatomy. The weakness in the abdominal wall through which the intestine protrudes may be part of your body’s natural formation. It can also result from:

Ventral Hernia Diagnosis 

To identify a ventral hernia, a health care provider may use multiple diagnostic techniques but will begin with a medical history and physical examination. The provider will inquire about and/or look for:

• Constipation, “narrow” or “thin” stool

• Lump or protrusion in the abdomen; you may be asked to stand and cough, which increases abdominal pressure and makes the hernia more pronounced and easier to diagnose

• Nausea, vomiting, fever or rapid heart rate

• Pain in the abdomen, especially around the protrusion

If the protruding portion of intestine has become trapped (incarcerated) within the abdominal wall, the blood supply to the intestine can get cut off. This may cause further complications such as necrosis (tissue death). If your provider suspects this is the case, additional diagnostics may include:

• Blood tests to look for infections caused by intestinal blockage or necrosis

• Ultrasound, MRI, CT or other imaging to check for blockage or actual location of the intestinal protrusion

Ventral Hernia Treatments

Specific treatment for a ventral hernia will be determined by your doctor based on multiple factors such as your general health, anatomy, extent and location of the hernia, and desired level of future physical activity. Treatment will generally consist of one of two types of surgeries:   

Open hernia repair

In this surgical procedure, also known as herniorrhaphy, the surgeon makes an incision in the abdomen above the hernia, pushes any protruding intestine back into the abdomen and repairs the opening in the muscle wall. Sometimes, in a procedure known as hernioplasty, the weak area is repaired and reinforced with mesh.

Laparoscopy

In this minimally invasive surgical procedure, the surgeon makes several small incisions in the lower abdomen and inserts a tubelike instrument equipped with a camera, called a laparoscope, into one of the incisions. The images are displayed on a large monitor that the surgeon uses to guide the operation. Using instruments inserted into the other incisions, the surgeon repairs the hernia with synthetic mesh and sutures or skin glue.

Robotic-assisted repair

Robotic-assisted repair is similar to laparoscopy, but the surgeon operates from a console controlling robotic arms. In this minimally invasive surgical procedure, the hernia contents are returned to their natural position in the abdomen and the muscle wall is repaired and reinforced with mesh.

Sports Hernia | Johns Hopkins Medicine

What is a sports hernia?

Despite its name, a sports hernia is not actually a hernia. The condition’s true name is athletic pubalgia. Although the symptoms are similar, the pain and pressure from sports hernias are caused by torn tendons that attach to the pelvis instead of an abdominal muscle separation and protrusion of intestine or other soft tissue.

Sports Hernia Causes

Sports hernias are typically caused by repetitive or explosive motions, especially those that require twisting of the pelvis such as football, hockey, soccer, rugby, skiing, running and hurdling. The soft tissues that perform these movements found in the lower abdomen and pubic area are most frequently torn or injured. The tendons that attach the oblique muscles to the pubic bone are especially vulnerable. In of the case of many sports hernias, the tendons that attach the thigh muscles to the pubic bone (adductors) are also stretched or torn.

Sports Hernia Diagnosis

To identify a sports hernia, a health care provider may use multiple diagnostic techniques but will begin researching how the injury occurred (mechanism of injury). He or she will then conduct a physical examination. Determining the mechanism of injury is important, because specific movements, such as those that involve the pelvis, are far more likely to cause sports hernias. A physical examination is necessary to rule out a true hernia, which can also be caused by athletic activity. Components of the physical examination include inspection, palpation—using hands to feel the injury, and testing of range of motion and motor strength.

If a diagnosis of a sports hernia or the severity of the injury is not clear, the provider may also order an X-ray, ultrasound, CT or MRI to look for injuries to the bone, nerves and soft tissue. An MRI is the most effective imaging technique for identifying tears in soft tissue such as tendon, ligament and muscle. Imaging diagnostics are also important, because lower abdominal and groin injuries tend to present pain in multiple or referred locations.

Sports Hernia Treatments

Specific treatment for a sports hernia will be determined by your doctor based on multiple factors such as your age, health, severity and type of tears, and the desired level of physical activity you wish to return to. Management of a sports hernia is multidisciplinary and nonsurgical treatment is recommended as a first step.

Sports hernia nonsurgical treatment

Mild to moderate symptoms can be typically remedied with rest, anti-inflammatory medication, ice and physical therapy.

Sports hernia surgical treatment

Patients with severe tears may require surgery to address the torn tendons. Many hernia specialists and general surgeons will consult an orthopaedic surgeon for this operation.

Much like the surgical options for true hernias, sports hernia repair can be done as a traditional, open surgery with one long incision or as a minimally invasive endoscopic procedure. In an endoscopy, the surgeon makes multiple small incisions and uses a tubelike camera, called an endoscope, to see inside the abdomen. The surgeon then sutures torn soft tissue or uses a combination of drill holes, anchors, sutures, skin glue and synthetic mesh to reattach fully ruptured ligaments.

If the small inguinal nerve located in the groin has been injured or scarred from years of physical activity, the surgeon will also sever this nerve during the surgery to relieve the patient’s pain. This procedure is called an inguinal neurectomy.

Sports hernia additional surgical treatment

In some cases of sports hernia, pain in the inner thigh continues after surgery. An additional surgery, called adductor tenotomy, may be recommended to address this pain. In this procedure, the tendon that attaches the inner thigh muscles to the pubis is cut. The tendon will heal at a greater length, releasing tension and giving the patient a greater range of motion.

Why are abdominal hernias dangerous and when is surgery needed?

November 2, 2021
Yunusov Bulat Timirzyanovich

Text not provided in full. You can read the entire article on FORM – SBER EAPTEKI’s blog. Hernias are always caused by overuse, but no two are alike. We tell you what is important to know about this common childhood problem, which can also occur in adults.

Hernias are always caused by overuse, but no two are alike. In different patients, the same pathology proceeds in different ways: one has an infringement, and the other may accidentally find out about a hernia during a routine examination. We tell you what is important to know about this common childhood problem, which can also occur in adults.

What is it

An abdominal hernia is a defect in the abdominal wall through which the abdominal organs, together with their surrounding tissues, extend beyond the abdomen. They are congenital or acquired – the method of treatment depends on this.

Any hernia consists of three elements: the exit site of the hernia (hernia neck), the hernial sac and the filling of the hernial sac. The essence of the operation is to eliminate the exit site, eliminate the hernial sac and return its contents to their physiological place.

But there are also hernias that do not need to be operated on. For example, a hernia of the white line of the abdomen with a defect of up to 0.5 cm does not require surgical intervention if it does not cause pain or discomfort.

The names of hernias on the abdomen correspond to the places of occurrence:

• groin
• umbilical (umbilical ring)
• linea alba (between rectus abdominis muscles)
• femoral (in the femoral canal).

The hernia is a ticking time bomb. At any moment, an organ of the abdominal cavity can come out of an existing tissue defect, and it will not return back – an infringement will occur. The vessels of the strangulated organ are compressed, and after 2-10 hours tissue necrosis occurs. The long time interval is due to the fact that the degree of clamping of the vessels is different: the better the blood circulation, the longer the life of the strangulated organ or tissue.

In children, hernias are detected during routine examinations before a kindergarten or school. The surgeon may see an inguinal hernia, which looks like a bulge in the groin area. This defect increases during physical activity, and decreases or disappears at rest. In boys with an inguinal hernia, the scrotum may increase in size. An examination by a specialist is enough to confirm the diagnosis.

Inguinal hernias in children under one year old can go away on their own. After a year, the probability of self-healing is less than 5%. Sometimes hernias that appeared before a year can turn into a dropsy of the testicle or a cyst.

Adults come in with an inguinal hernia when it causes pain, a cosmetic defect, or discomfort. It looks like a “bump” in the groin area, which either increases or decreases, causing pain in the testicles, sometimes in the groin. If these symptoms did not make a person come to the doctor for treatment, then he usually comes with a strangulated hernia and severe pain. In such cases, an emergency operation is performed. If the strangulation lasts more than 12 hours, a part of the bowel will need to be removed.

If an umbilical hernia is suspected, the surgeon should feel the navel with a finger. Only in this way can one feel that there is a hole that connects the abdominal cavity with the navel. A protrusion of the navel is more common in children under five years of age.

It is easier to identify umbilical hernias in children under one year old, because due to the weakness of the abdominal muscles, the navel and the skin around it are greatly stretched and protrude. In children from the age of five, a convex navel does not always indicate the presence of a hernia. Sometimes these are the consequences of a previous defect, which closed on its own after strengthening the abdominal muscles of the child. Therefore, such hernias are not operated on in the first three years, waiting for a possible recovery without intervention.

Hernias of the white line of the abdomen can be diagnosed by touch. If the patient has a lot of fatty tissue on the abdomen, an ultrasound scan is performed to confirm or exclude the diagnosis.

Femoral hernias are often incarcerated, and therefore they are usually diagnosed only in cases of incarceration, when the patient experiences severe pain and discomfort even at rest.

Inguinal hernia

Until the age of 15, all inguinal hernias are congenital, they are not associated with a defect or weakness of the abdominal wall.

During the development of a boy, the testicles descend from the abdominal cavity into the scrotum. At this moment, they grab a “piece” of abdominal tissue and pull it along. This “piece” is called the vaginal process of the peritoneum. After birth, it grows together from the inside, and the space between the testicle and the peritoneal cavity closes forever.

If this space is not closed, the abdominal organs exit through it into the inguinal canal and even into the scrotum. In severe cases, the bladder enters the inguinal canal.

In girls, the area of ​​the inguinal canal is a weak anatomical zone in which an inguinal hernia may appear. But this happens less frequently than in boys.

In adults with inguinal and umbilical hernias, a mesh is used during the operation. The mesh is not a frame for strengthening, but an additional foreign body that stimulates the development of connective tissue in order to strengthen the abdominal wall.

“Modern inguinal hernioplasty in adults is always the use of a mesh implant,” explains GMS Clinic surgeon Bulat Yunusov, “it is better and more correct to use any mesh than not to use it at all.”

You can read the continuation of the article at the link to FORM – SBER EAPTEKI’s blog.

Igor Nelyubov, a pediatric surgeon at the FEFU Medical Center, spoke about the occurrence of inguinal hernias in children and methods of their treatment

December 15, 2017

A common cause of concern for mothers is the occurrence of an inguinal hernia in a child. Pediatric surgeon, head of the operating department of the FEFU Medical Center Igor Nelyubov spoke about the causes, risks and methods of treating this disease.

Inguinal hernia is a pathological protrusion of the peritoneum into the inguinal canal, – explains Igor Vladimirovich. – The contents of the hernial sac are intestinal loops, and in girls – the ovary and fallopian tube. In utero, in boys, a canal is formed that runs from the abdominal region to the inguinal region. This is due to the process of lowering the testicle, the testicle pulls a part of the peritoneum from the abdomen to the groin. This creates conditions for the possible movement of internal organs. Therefore, the occurrence of inguinal hernia in boys is 6-10 times more common. In girls, the cause of a hernia is the pathology of the maturation of the uterine fixing element, the so-called round ligament of the uterus.

By the time of birth, this communication with the abdominal cavity closes on its own in most children. When this does not happen, an inguinal hernia is formed. Clinically, it can manifest itself both from birth and much later. Visually, a hernia looks like a small “swelling” in the groin. It increases with “straining” and is easily set inward. Often, parents do not notice the manifestations of an inguinal hernia before it is infringed, since it is not accompanied by pain, but becomes visually noticeable only when it reaches a significant size.

The main danger of a hernia is its probable infringement. An infringement is an island-like “jamming” of the contents of the hernial sac (intestinal or ovarian loops), pinching of the strangulated organ by a narrow hernial orifice, and, as a result, impaired blood supply and loss of organ viability for several hours. Often, the infringement of a hernia occurs against the background of an increase in intra-abdominal pressure: crying, screaming, coughing, constipation. Infringement of an inguinal hernia is manifested by severe anxiety, cramping pains in the abdomen, and sometimes vomiting. On examination, the swelling in the inguinal region is dense, unreducible. In this situation, the only right decision is to call an emergency room and hospitalize in a surgical hospital. If signs of infringement persist, urgent surgery is required. Technically, surgery for a strangulated hernia is more difficult and comes with a greater risk of complications.

According to the classical canons of pediatric surgery, surgical treatment of inguinal hernia is indicated after the diagnosis has been established, including newborns. In practice, as a rule, operations for inguinal hernia are performed on children over the age of 6-12 months. It is believed that before this age, the operation is technically somewhat more difficult, and anesthesia for the child is safer at this age. “Postponing” the operation is possible provided that the hernia is not prone to infringement. The principle of an inguinal hernia operation is to separate the abdominal cavity and the hernial sac, preventing the possibility of internal organs getting into it. The operation is delicate, requiring good technique – accurate and careful preparation with the preservation of all anatomical structures: the spermatic cord – the vas deferens and testicular vessels, as well as the inguinal nerve.

Unlike adults, mesh implants are not used in children. The operation is always performed under general anesthesia. The average duration of the operation is 15-30 minutes. In addition to traditional hernia repair, there is a technique for endovideosurgical correction of this disease.