Hernia (cont.)
What other types of hernias are there?
Epigastric, umbilical, incisional, lumbar, internal, and Spigelian hernias all occur at different sites over the abdomen in areas
that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are
commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be
extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external
evidence of a lump.
How is a hernia repaired?
A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia.
In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the
hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define
the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a
plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a
piece of cloth. One of the problems with this approach is that it can put excessive strain on the surrounding tissues through which the
sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the
formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of
many different methods of suturing the deep tissue layers in an attempt to provide better results.
In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative
technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a
permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into
the local structures. This has proved to be a very effective means of repair.
After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques (see below).
Next: What is laparoscopic hernia repair? »
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