By Robert Ripley, MD
Hernias are enlarged natural opening in the body or separations of muscle that allow underlying tissue to protrude through them. An example of a natural opening hernia is the hiatal hernia that allows the stomach to protrude into the chest cavity. Separations of muscle can occur in previous incisions. Abdominal incisions are the most common for this problem, and can allow portions of the small and large bowel to herniate through the separation.
The most common hernia is the inguinal hernia, and it occurs most often in men. It presents as a small swelling in the groin that will go away when the person lays down. Symptoms vary from mild discomfort to sharp pain.
Incarcerated and strangulated hernias are complications that can occur. Incarcerated hernias trap tissue in the hernia so that it can’t be reduced. If the tissue is trapped tightly so that its blood supply is cut off, the incarcerated hernia becomes strangulated and requires immediate surgery.
The most common ways to repair hernias is to use biologic or prosthetic mesh, myofascial flaps, and primary suture repairs. The age and size of the patient, size and location of the hernia, previous surgery, other medical problems, and the lifestyle of the patient are factors in deciding what type of repair is best.
In my practice, I frequently see patients with large or recurrent hernias of the abdominal wall. These repairs are complex, and frequently require an advanced technique known as myofascial trunk flaps. In this repair the general and plastic surgeon combine their skills to close the hernia and return the abdominal muscles to their normal position.