A hernia is a bulge in the abdominal wall. Hernias often occur in the groin and are called inguinal or femoral hernias. They also occur at the umbilicus and through old surgical incisions. In each case there is a weakness in the abdominal wall which allows intra-abdominal contents to leave the abdomen. The hernia can cause an unsightly lump but worse still can cause acute pain and even bowel obstruction.
Hernias are diagnosed through history where there is an intermittent lump emerging through the abdominal wall. The lump usually appears with straining and coughing and often disappears when supine and relaxed. Acute hernias can be associated with pain while long standing hernias can be painless but generate large masses. Physical examination is performed lying and standing and allows demonstration of a bulge.
Investigations include abdominal ultrasound and CT scans to prove the existence of a hernia and to check the anatomy.
Treatment is usually required given that adult hernias do not resolve but actually tend to grow slowly over time. The smaller the hernia at the time of repair the more likely that the repair will be successful. Hernias can also be associated with complications. If the contents of a hernia become trapped at the opening in the abdominal wall then pain worsens and the abdominal contents of the hernia, particularly bowel, can be injured. This is a surgical emergency requiring urgent surgery. Elective repair is then preferable to prevent such complications.
For patients with many medical problems, hernia surgery may prove too risky and then, trusses and support garments may be required. With newer less invasive techniques and different anaesthetic approaches surgery is usually however, possible.
For inguinal and femoral hernias, laparoscopic approaches offer smaller incisions and usually a more comfortable immediate post-operative course and therefore, an earlier return to work.
