Don’t Let a Hernia Put a Strain on Your Life

Hernias happen. They happen to overweight, out-of-shape smokers, and they happen to highly trained athletes. They happen to people who strain too much while lifting. And they happen to those who merely sit in a chair. While they are more common in men, hernias also occur frequently in pregnant women.

A hernia happens when a small portion of tissue from inside pushes through a weak spot in the abdominal wall. In about 75 percent of cases, this occurs in the inguinal canal, the area where the abdomen meets the thigh. Men are 25 times more likely than women to develop an inguinal hernia, and the bulge sometimes protrudes into the scrotum.

Other abdominal hernias likely to affect women as well as men include femoral (also in the groin, nearer the thigh), umbilical (around the naval) and epigastria (above the stomach).

It was once believed that hernias were caused by heavy lifting, straining, coughing or sneezing. Such activities may well bring on a hernia if a weakness already exists in the abdominal tissue, but the current belief is that the weakness is usually caused by impairment in collagen metabolism. When the predisposition exists, smoking, infection and obesity–as well as straining–can increase the risk. But even fit, muscular individuals develop hernias.

If you have a hernia, you may not know it until a doctor detects it on a routine examination. When you’re asked during a physical to turn your head and cough, the goal is to feel for a hernia.

A hernia can be seen or felt as a tender bulge or round lump that becomes more prominent when you cough, strain or stand up. In the early stages, it’s possible to push the protruding tissue back in place temporarily. In medical terms, a bulge that can be pushed back in place is known as a “reducible” hernia. When the condition worsens, the lump can no longer be pushed back.

The hard part about dealing with a hernia is the uncertainty about what to do. A break in the abdominal wall will not get better on its own and is likely to get worse. Various trusses, belts and other devices to hold the hernia in have had mixed success.

And a serious problem could occur if fatty tissue or an organ gets trapped inside the hernia (known as “incarceration”) and deprived of blood flow (“strangulation”). Because of the risk of gangrene and tissue death, strangulation is a life-threatening condition requiring emergency surgery.

Sooner or later, most persons with a hernia have it surgically repaired. This involves re-positioning the internal tissue and repairing the defect in the abdominal wall.

About a million procedures are performed each year; it’s one of the most common types of surgery and one of the safest. Complications include pain, discomfort and recurrence of the hernia.

Because of the risk of strangulation, many persons undergo surgery right away, even if the hernia is not causing pain or other symptoms. A study published in the Journal of the American Medical Association [January 18, 2006] found, however, that immediate action may not always be necessary.

More than 700 men with hernias causing only minimal symptoms were recruited over a five-year period at five academic and community hospitals and randomly assigned either to watchful waiting or traditional surgery. Over a two to three year follow-up period, researchers found that the overall rate of pain and other complications was similar in the two groups and concluded that “watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.”

Of the men assigned to watchful waiting, 23 percent crossed over to the surgery group–primarily because their pain had gotten worse and the hernia was protruding more.

Infants and children are more likely than adults to have tissue become trapped (or incarcerated) in a hernia; as a result, they may be advised to have surgery sooner rather than later.

Adults choosing to delay surgery might need to wear a truss, belt or other device in order to handle every day activities without pain or discomfort. It’s important, however, to be instructed in the use of a truss since an improperly worn device could actually increase the risk of incarceration.

While hernia surgery is usually worry-free, recurrence has been a problem. The traditional repair involves suturing together the ends of the defect in the abdominal wall. With the resulting increased tension on the abdominal muscle tissue, another tear is eventually likely to happen.

Newer surgical approaches aim to reduce tension by stitching a mesh patch made of synthetic material into the defect. The recurrence rate has been shown to be dramatically improved over the traditional method of suturing the tissue together. Laparoscopic repair of some hernias is also an option in some patients and should be discussed with your doctor.

As far as the patient is concerned, the best procedure is usually the one with which the surgeon has had the most experience.

If you have a small hernia that doesn’t cause symptoms, there’s no need to let it worry you. When it becomes large enough to cause you pain, the surgeons at Brattleboro General Surgery will be glad to consult with you.

Thomas H. Lewis, MD, is a general surgeon and former practice partner at Brattleboro General Surgery

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Umbilical Hernia | Johns Hopkins Medicine

What is an umbilical hernia?

Unlike most hernias, which develop in adolescence or adulthood, 20 percent of babies are born with umbilical hernias. An umbilical hernia occurs at the umbilicus (belly button) when a loop of intestine pushes through the umbilical ring, a small opening in a fetus’ abdominal muscles through which the umbilical cord—which connects a fetus to its mother while in the womb—passes. Umbilical hernias occur most often in newborns, and 90 percent will naturally close by the time the child reaches 5 years of age.

Umbilical Hernia Causes

After birth, the umbilical cord is no longer necessary, and the opening in the abdominal muscles closes as the baby matures. Sometimes, these muscles do not meet completely, leaving a small hole or gap. A loop of intestine can move into and even penetrate the opening between abdominal muscles and cause a hernia.
Umbilical hernias occur most often in infants but can also occur in adults. The most common causes of umbilical hernias in adults are:

Umbilical Hernia Diagnosis

Hernias are usually diagnosed during a physical examination by a health care provider. The provider will look and feel for a bulge or swelling in the belly button area. The swelling may be more noticeable when a baby cries and may get smaller or go away when a baby relaxes or rests on its back. During the examination, the provider will determine if the hernia is reducible—if it can be pushed back into the abdominal cavity.

The provider will also look for and complete a medical history to determine if the umbilical hernia has become incarcerated (trapped within the abdominal opening), a serious medical condition in which the protruding intestine becomes trapped and deprived of blood supply. The intestine can quickly become necrotic if not repaired, which requires surgical removal of the affected intestine. Symptoms of a strangulated umbilical hernia include:   

• Abdominal pain and tenderness

• Constipation

• Fever

• Full, round abdomen

• Red, purple, dark or discolored bulge

• Vomiting

The provider may order blood tests to look for signs of infection resulting from the strangulated intestine. They may also order a barium X-ray, ultrasound, MRI or CT to examine the intestine more closely, especially if the hernia is no longer reducible.

Umbilical Hernia Treatments

Specific umbilical hernia treatment and timing will be determined by the surgeon based on multiple factors such as the child’s age, general health, medical history and whether the hernia is reducible or strangulated. By age 1, many umbilical hernias will have closed on their own without surgery. Nearly all umbilical hernias will have closed without surgery by age 5.

In general, if the hernia becomes bigger with age, is not reducible or is still present after age 3, the child’s provider may suggest that the hernia be repaired surgically. If the hernia is strangulated and cannot gently be pushed or massaged back into its proper place within the abdomen, the surgeon will generally recommend immediate surgery.

Under general anesthesia, a small incision is made in the umbilicus (belly button). The loop of intestine is placed back into the abdominal cavity, and the incision closed. Sometimes a piece of mesh material is used to help strengthen the area where the muscles are repaired.

treatment, the cost of an operation to remove an umbilical hernia in St. Petersburg

An umbilical hernia is a surgical pathology in which the abdominal organs go beyond their physiological position through the structures of the umbilical ring.

In the hernial sac, intestinal loops, parts of the omentum or peritoneum may be found. This disease is not so common in adults, more often it occurs in childhood. However, it takes place in the structure of surgical diseases and requires careful attention.

Why does an umbilical hernia occur?

The main mechanism for the occurrence of a hernia in the navel is the weakness of the muscles of the anterior abdominal wall. Their edges can diverge, thereby freeing up space for the formation of a hernia. This process occurs under the influence of a number of provoking factors:

• Consequences of pregnancy. An increased risk is multiple pregnancies, significant fetal size, or polyhydramnios. Increased pressure on the anterior abdominal wall of a woman can provoke a hernia in the future.
• Weight gain or vice versa – rapid loss of body weight. Uneven load on the abdominal wall leads to muscle weakness.
• Increased intra-abdominal pressure, which occurs in some pathologies.
• Regular constipation.
• Features of connective tissue, impaired collagen metabolism.
• Postponed injuries of the anterior abdominal wall.
• Operative laparotomy interventions.
• Low physical activity.

In order for a certain factor to lead to the appearance of a hernia, its long-term influence or a combination of several causes is necessary. Congenital features of the muscles of the abdominal wall also play a significant role.

What are the manifestations of an umbilical hernia?

The clinic of the disease depends on the precise localization of the hernia, the size of the hernial sac, the involvement of the internal organs in the process, as well as the indicators of reducibility. In some patients, the pain symptom is expressed constantly, while in others there is only slight discomfort. If the condition worsens, the clinical picture becomes more pronounced and varied.

You can recognize an umbilical hernia by the following signs:

• Protrusion in the umbilical region. It occurs gradually and in the early stages does not bring discomfort to a person. you may not even notice it at first. In the supine position, the hernia is reduced and disappears. However, the longer the pathology proceeds, the more significant the protrusion and deformation of the anterior abdominal wall in the navel area becomes. Accordingly, a large hernia cannot be corrected.
• Change in the size of the hernia depending on the position of the body. If a person is standing, the hernia can increase, as well as change its size when coughing, exerting, exerting, eating;
• Soreness occurs when there are adhesions or strangulation has occurred. Patients with an umbilical hernia also experience discomfort and soreness after exercise;
• With a large size of the hernial sac, the skin over it becomes thin and allows you to feel the peristalsis of the intestine;
• Involvement of the digestive system leads to constipation, belching, nausea and bad taste in the mouth. These symptoms indicate the appearance of an adhesive process and aggravation of the condition.

Indications for surgery for umbilical hernia

Hernioplasty in this case is a planned operation, which is prescribed by the surgeon from the moment the pathology is detected. Conservative treatment of umbilical hernia is possible only at the age of 6 years, for which special gymnastics and exercises are prescribed. An adult has already completed the formation of the anterior abdominal wall and muscles, so it is necessary to resort to surgery.

Indications for emergency surgery are aggravated conditions:

• infringement of the contents of the hernial sac;
• involvement in the inflammatory process of the peritoneum;
• occurrence of intestinal obstruction;
• bleeding.

If you delay the operation in such cases, there is a necrotic change in the soft tissues. This can lead to general complications and is life threatening.

Diagnostic program for hernia in the umbilical region

The diagnosis begins with a questioning of the patient. It is important for the surgeon to find out the circumstances of the onset of the disease, its course. An objective examination includes examination of the hernia, palpation of the abdominal wall, a detailed examination of the patient’s appearance.

Additional diagnostic methods:

• abdominal x-ray;
• ultrasound examination of hernia;
• in difficult cases (severe obesity) – computed tomography of the abdominal cavity.

If the patient’s condition is critical, laboratory diagnostic methods may be needed. They will show the state of metabolism in the body, as well as the readiness of a person for the upcoming surgical intervention.

Modern treatment of umbilical hernia

Treatment of a hernia can prevent serious complications, and also returns the patient to comfort and the usual mode of life. Many patients hope for self-reduction of the hernia, but for adult patients, only surgical treatment is indicated.

Umbilical hernia surgery

There is conventional surgery and laparoscopic hernioplasty , in both cases with the possible use of a mesh implant.

Surgical treatment with an open method is carried out according to classical techniques. For this, the umbilical ring is sutured in the extreme places of the aponeurosis. Sutures are applied in a vertical or transverse position. Such an intervention has a long recovery period, as well as a high risk of relapse.

Mesh hernioplasty has a number of advantages. The mesh implant strengthens the abdominal wall. The surgeon can place it under the aponeurosis or above it. Materials for implants do not cause reactions from soft tissues, are safe and resistant to damage. Such treatment successfully helps the patient to return to the usual mode. The operation has a shorter and more comfortable rehabilitation period, reduces the likelihood of relapse.

Laparoscopic surgery is the best treatment option for a hernia. Hernioplasty using a laparoscope is performed through several small incisions, which reduces the trauma of the intervention. Such treatment is most effective: after all, the mesh is attached from the side of the abdominal cavity, and not from the aponeurosis. The patient stays in the hospital for one to several days and, after confirmation of a satisfactory condition, is discharged home.

In the postoperative period, the main priority is the prevention of local complications. The attending physician monitors the patient’s condition for inflammation, suture failure, and bacterial complications. High-quality nutrition and compliance with hygiene standards are a prerequisite for keeping a patient in the clinic. The determining factor in the rehabilitation period is the type of surgical intervention. The laparoscopic technique significantly reduces the risk of postoperative complications.

Discomfort after surgery lasts only a few days. This is facilitated by high-quality anesthesia and minimal tissue trauma. It is necessary to consult with your doctor about returning to your usual activities, sports and work. The surgeon takes into account the age of the patient, his physical form, activities and makes recommendations. In the postoperative period, depending on the size of the hernia, the age of the patient, his constitutional status, it is recommended to wear a bandage on the anterior abdominal wall. The attending physician may prescribe repeated consultations for a preventive examination. Failure to follow these tips can lead to recurrence of the hernia and the need for a second operation. If symptoms recur, you should contact your doctor, as he knows the characteristics of the body and will qualitatively assess the situation.

Abdominal wall hernia removal free of charge under CHI

Abdominal hernia is one of the most common reasons for visiting surgeons: it occurs in 6-7% of men and 2.5% of women during their lifetime [1]. Many people put off hernia treatment, but in vain: high-tech methods allow you to recover in a matter of days after surgery. Dmitry Sergeevich Gavrukov, head of the surgical department No. 4 of the GKB named after I.I. S.S. Yudina

What is a hernia and why does it occur?

A hernia is a disease in which the contents of the abdominal cavity exit through a hole formed in the abdominal wall. A hernia consists of a hernial sac, hernial contents and hernial ring. The gate is the defect of the abdominal wall through which the contents come out into the subcutaneous fat. This content can migrate to the hernial sac and back – and so on throughout the day back and forth.

How to understand that there is a hernia of the abdominal wall?

The patient usually finds it himself. There is some protrusion on the abdomen or in the groin. It can independently retract into the abdominal cavity and do not disturb for some time, and then reappear. A person may notice the asymmetry of the anterior abdominal wall, experience pain. Usually it has a jerking, cramping character and is stopped by self-reduction of the hernial protrusion.

Types of hernias of the abdominal wall

Localization of hernias most often occurs in the groin (inguinal hernia), in the umbilical region (umbilical hernia), in the projection of the white line of the abdomen (hernia of the white line of the abdomen). There is also a postoperative hernia (usually in the projection of the postoperative scar).

What situations require surgery?

Hernia itself is an absolute indication for surgery. An exception is the expansion of the umbilical ring up to 1 cm, in which the contents of the abdominal cavity do not stick out – that is, this is not yet a hernia. But if the defect of the abdominal wall is more than 1 cm, this is an indication for surgical treatment.

How is the operation to remove a hernia of the abdominal wall performed?

Two options: open surgery and laparoscopic intervention.

Open operation

Open operation is the most traumatic: the incision can be 8-10 cm, depending on the size of the hernia. But there are situations when an open operation is indicated. For example, at a high risk of increased intra-abdominal pressure, in aged patients with severe concomitant diseases, in the case of previous multiple abdominal operations. The latter is a relative contraindication, since here the factor of the surgeon’s professionalism, his skills, as well as the level of equipment in the operating room are of particular importance.

Laparoscopic intervention

Laparoscopic intervention is performed without going into the abdominal cavity. We work in the retroperitoneal space. The anterior abdominal wall, like a sandwich, consists of several layers, and we need to be in the right one in order to approach the hernia from the inside. The operation uses a 10mm port to enter the abdominal cavity and two 5mm ports to expose the hernia. Total – three cuts with a total length of 2 centimeters.

The surgeon visualizes the hernial protrusion on a large high-resolution monitor, which allows you to perform a high-quality operation and eliminate the risk of complications.

Next, we isolate the hernial sac and bring its contents into the abdominal cavity. A mesh implant is installed on the hernia gate, which closes the space between the layers. We do not sew anything, we do not cross, we do not injure the layers of the anterior abdominal wall. Generally speaking, there is nothing to get sick after the operation.

How is recovery going?

After laparoscopic surgery, the patient spends up to three days in the hospital, taking into account the examination. Within two weeks it is necessary to refrain from physical activity, since excessive exercise can lead to damage to tissues that have not fused together. You can return to your usual work activity in a week if you work in an office. Of course, if the work is physically demanding (for example, if you are a loader), then it will take a month to recover.

What are the contraindications for surgery?

Contraindication is the presence of oncological diseases – in the case of planned treatment. In emergency situations, they operate even if they are available. Also, contraindications are diabetes mellitus in the stage of decompensation, the constant use of blood-thinning drugs – anicoagulants and desogregants (but with their correct cancellation, surgical treatment is possible), as well as the presence of purulent-septic disease. During pregnancy, the operation is not performed in a planned manner.

What happens if the operation is not performed?

There is a superstition that a hernia can go away on its own. This is impossible. But a number of complications are likely. The most dangerous complication is strangulation of the hernia. Against the background of increased intra-abdominal pressure – for example, when lifting weights – several intestinal loops come out into the hernial orifice. Then they close, and the contents of the hernial sac are infringed. This is an extremely dangerous condition that requires emergency hospitalization. If a person is in the operating room within the next few hours, the organ can still be saved. If not, the tissues become necrotic. Life can be saved, but part of the intestine has to be removed. This is urgent surgery with all the ensuing complications.

Is it possible to perform an operation to remove a hernia in Moscow for patients from other cities?

Our center is known as one of the leading herniological centers in the country, where patients come from all over Russia. A resident of any region can go to the site, register and describe the medical history by attaching a picture of a hernia. Then we study the documents, set the date of hospitalization. Day after day, a person arrives in Moscow, goes to the hospital – that is, you do not have to live in a hotel, waiting for the date of the operation. As a rule, the next day after hospitalization, an operation is performed, and a day or two later he goes home.

Do I need to come to Moscow again after the operation?

No, after discharge, only consulting assistance from a surgeon at the place of stay is required.