The abdominal wall is a strong muscle and connective tissue structure that wraps the abdominal organs like an envelope and gives our body its shape. This envelope has some potential weak points. Intra-abdominal organs (especially adipose tissue and intestines) pass through the abdominal wall through these weak points and cause swelling under the skin. It is also called hernia. Abdominal wall hernias are treated surgically by General Surgery specialists.

Conditions called herniated disc or neck hernia among the people fall within the field of Brain and Nerve Surgery specialists. In these cases, the disc-shaped structures between the vertebrae break the membrane around the spine and come out, putting pressure on the spinal cord or nerves. Back/neck hernias and abdominal wall hernias, which are often confused due to their names, occur in different parts of the body and with different mechanisms, and the doctors who treat/treat them are different.

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What types of abdominal wall hernias are there?

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There are some potential weak spots in the abdominal wall, both congenital and later. Congenital points:

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1. Both inguinal regions where the testicles in the abdomen pass through the abdominal wall while coming to their normal places in the scrotum in males. The groins are also weak in women. These areas contain the inguinal canal and contain the veins leading to the testicles and the semen canal in men, and some suspensory ligaments of the uterus in women.

2. The navel, which is the place where the veins that provide the baby's nutrition from the mother enter the baby's body while in the mother's womb. After the baby's umbilical cord falls off, a hard scar tissue forms in this area that creates the usual appearance of the navel, but the area's potential weakness remains, and some people may develop an opening in the abdominal wall in this area later in life. In infants, this opening mostly closes spontaneously within the first four years of age. If it does not close or if it occurs at a later age/adult life, it should be treated with surgery.   _cc781905-5cde-3194-bb3b-136bad5cf94-5cdebb-cc7831 136bad5cf58d_

3. The epigastric region is the line where the muscle sheaths located on both sides meet in the midline above the navel level. The line where the two muscle sheaths meet may occasionally be more flexible than it should be, resulting in a hernia-like appearance or sometimes an opening in the abdominal wall.

4. Possible weak points located at the intersection points of the muscles located layer by layer within the abdominal wall folds can cause hernias with a special name such as Spiegel's hernia or hernias such as lumbar hernia.

 

The weak points that may occur later are the incisions on the abdominal wall caused by surgeries. During the operations, an incision is made on the abdominal wall along with the skin, and these incisions are closed after the operation is over. During the healing process, these incisions are potential weak points and are risky in terms of hernia formation. The negativities to be experienced in the postoperative period increase this risk.

For hernias to occur, the abdominal wall must be forced. Situations that increase intra-abdominal pressure create this strain. Conditions such as carrying excessive and prolonged heavy loads, constipation requiring constant straining, and prolonged coughing increase intra-abdominal pressure. In addition, the problems that may arise in the abdomen after the operation will negatively affect the wound healing, thus paving the way for the hernia.   

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Why should abdominal wall hernias be treated?

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There are many difficulties that a hernia brings to your personal life. Its symptoms vary. While small hernias are manifested by pain, as the hernia grows, it causes a swelling under the skin, causing a physical appearance disorder and restriction in daily movements. This situation prevents the person from moving freely in society and damages his self-confidence. Since hernia is a growing and progressive disease unless treated, it should be treated as soon as possible after detection.

 

In addition to eliminating the complaints of the patients, abdominal wall hernias should be treated in order to avoid more serious medical problems. As stated before, abdominal wall hernias occur when intra-abdominal organs pass through the openings in the abdominal wall and form a swelling under the skin. Often, organs constantly enter and exit through these openings. From time to time, due to the high intra-abdominal pressure, a large volume of organ passes through the abdominal wall and settles under the skin, but due to the large volume, it cannot return to the abdomen. This condition is called compression of the hernia and can lead to intestinal obstruction. If this process is prolonged, the blood vessels that feed the organs will be under pressure and can cause decay, a condition called strangulation of the hernia. Both conditions should be treated surgically under emergency conditions. Since surgery in emergency conditions may involve unpredictable risks for both the patient and the physician, surgical treatment should be performed as soon as possible by providing ideal conditions when a hernia is detected. This is much more comfortable for both the patient and the physician.

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Is there a treatment option other than surgery for abdominal wall hernias?

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The principle of treatment in abdominal wall hernias is basically the same as repairing a hole in a wall. It is clear, therefore, that a mechanical problem must have a mechanical solution. In today's conditions, there are no drugs or methods (exercise, etc.) to close the openings in the abdominal wall by creating new and solid tissues. Until a better one is developed, surgery will be the only option in the treatment of abdominal wall hernias. Inguinal ligament etc. Methods like this do not solve the problem, they can only provide temporary relief.  

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What options are available for surgical treatment?

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The basic principle of treatment is to repair an opening in the abdominal wall without tension with a patch. This patch can be created from the body's own tissues, or some synthetic materials can be used. With the development of new technology materials, the use of synthetic materials has become very common today. Synthetic patches are advantageous for tension-free repair. When the patch is placed on the body, it is perceived by the body as a foreign body and a hard tissue forms around it. This hard tissue provides a solid and durable closure of the hole in the hernia area.  

Hernia surgeries can be performed with open or closed (laparoscopic) methods.   _cc781905__cdef19-5cde-3194-bb3b-136bad5cf58d__cc781905__cde58-3194 bb3b-136bad5cf58d_

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What are the advantages and disadvantages of open and laparoscopic surgery options, which method should be applied to which patient?

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There is no difference between the two methods in terms of success, but since the incisions made in laparoscopic surgeries are smaller, postoperative pain is significantly less. While both repair with the patient's own tissue and synthetic patch can be used in open surgeries, it is obligatory to use synthetic patch in laparoscopic surgeries. Considering that the currently accepted ideal treatment of hernia is repair with synthetic patches, this should not be seen as an advantage of open surgery. Especially in surgical hernias, it may be necessary to make large incisions in direct proportion to the size of the hernia. In such cases, laparoscopic methods that allow the problem to be solved through very small incisions provide significant comfort for both the patient and the physician. In large hernias, the laparoscopic method shortens the hospital stay. Laparoscopic method is offered to the patient as the first choice in all hernia types due to the comfort it provides to the patient in the postoperative period.

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What kind of process awaits the patient after the operation in the treatment of abdominal wall hernias?

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In the vast majority of hernia surgeries (assuming no problem occurs), the hospital stay is short. In inguinal hernias, in umbilical hernias that are not very large, the hospital stay is one night. In surgical site hernias, this period may take up to a week, albeit rarely, depending on the size of the hernia. Application of the laparoscopic method will shorten the hospital stay. After the patient returns home, he is invited to the hospital for a control examination on the seventh day of his surgery, and the patient does not have to come to the hospital for a check-up, mostly, the doctor is consulted if there is any complaint.

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Since the abdominal wall is repaired, the surgical area will be weak at first, so heavy exercise and strain should be avoided until the wound healing process here reaches a certain stage. Patients can return to their daily lives 48 hours after the surgery. The patient should rest between 3 and 7 days, depending on the weight of the job and the pain condition. The vast majority can return to work (not requiring heavy physical activity) within 4-5 days. Lifting more than 5 kg or heavy sports for six months is not recommended for those who do not do active sports. Active athletes can start routine training after 6 weeks.

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What kind of problems can occur after such surgeries?

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The most important problem that may occur during or in the early postoperative period is bleeding in the operation area. Rarely, second surgeries may be required to control bleeding.  During surgery, especially in inguinal hernias, these tissues may be injured because they are worked very close to the semen, testicular vessels and nerves in men. This condition can cause infertility, so it should be studied very carefully.

After a well-performed hernia surgery, the recurrence rate is very low if the patient's risk factors are not too great. After hernia surgery, the most important issue to solve is pain. Prolonged pain often disappears over time, but in some cases, treatment options such as injection of medication into the painful area and re-surgery may be considered. It is very important that the patient does not gain weight so that the hernia does not recur after surgery hernias.