An abdominal wall hernia is a protrusion of part of the bowel through a defect or an area of weakness in the abdominal wall. Hernias can be congenital or acquired later on during life. They are very common especially among males and account for almost 1 million surgical operations per year in the U.S.
Abdominal wall henias are usually classified according to their location in the abdominal wall, as follows:
Groin hernias (inguinal and femoral hernias)
Inguinal hernias occur above the inguinal ligament (Poupart’s ligament), whereas a femoral hernia occurs below the inguinal ligament. They both appear as a bulge in the groin, labia (skin folds surrounding the vaginal opening) and upper thigh. A large inguinal hernia that extends into the scrotum in men is called a scrotal hernia. Inguinal hernias account for 80% of all hernias and are more common in men. Femoral hernias are more common in women and must always be repaired when detected because of a high risk of strangulation.
It occurs through the umbilical ring and is mostly congenital. Sometimes they are acquired in adulthood, usually secondary to obesity, pregnancy, peritoneal dialysis etc.
It occurs through an incision from a previous abdominal surgery. About 8-10% of patients having open abdominal surgeries will develop later on an incisional hernia. Factors predisposing to incisional hernias include diabetes, malnutrition, use of steroids, chronic cough and cancer.
A sportsman’s hernia is a painful, soft tissue injury that happens in the groin area. It is most commonly seen in athletes that engage in sports that require sudden changes in direction or excessive twisting, such as soccer, tennis and hockey.
Unlike, a traditional hernia, a sport’s hernia does not imply a defect in the abdominal wall through which part of the bowel bulges out, thus making the diagnosis sometimes really challenging. On the contrary, a sport’s hernia occurs when the oblique muscles in the abdominal wall suffer a tear causing chronic pain that is aggravated by exercise and relieved by rest.
The pain may linger for weeks or months and physical examination often reveals inguinal tenderness but no palpable ‘lump’ in the groin area.
To aid the diagnosis, ultrasound or even M.R.Imaging of the groin area may be required to identify the tissue damage.
Resting the groin muscles, physiotherapy and NSAIDs can sometimes resolve the problem. However, in most cases surgery is needed to repair the tear and reinforce the abdominal wall.
Surgical repair can be both open and laparoscopic. The laparoscopic approach using a mesh that is secured in place by staples or glue is currently the most favorable among surgeons due to its excellent outcome and faster recovery.