Abdominal Wall Hernias
What is the anterior abdominal wall? What is in its structure?
The area between the rib folds and the groin areas is called the anterior abdominal wall. The anterior abdominal wall consists of skin, subcutaneous fat tissue, muscles, the sheaths surrounding the muscles, and the abdominal membrane. In the middle region of the anterior abdominal wall, there is a structure called the navel, where the baby is connected to the mother with a cord in the womb and which closes after birth and becomes the umbilical cavity.
What is an abdominal wall hernia?
Abdominal wall hernia is the protrusion of intra-abdominal organs through any congenital or acquired weak point in the anterior abdominal wall, other than the groin area.
How many types of anterior abdominal wall hernias are there?
- Epigastric hernia: Hernias between the navel and the junction of two ribs.
- Umbilical (belly) hernia: Hernias in and around the belly button
- Incisional hernia: Hernias from incision sites after abdominal surgeries
How and in whom do abdominal wall hernias occur? Am I at risk?
There are many risk factors for anterior abdominal wall hernias. These risks may be congenital or may develop later. Situations that increase intra-abdominal pressure somehow cause organs to protrude from these developing weaknesses.
The following situations should be kept in mind when identifying risky individuals:
- Obesity
- Chronic cough
- Pregnancy
- Severe vomiting attacks
- Do not pull up heavy thing
- Constipation/difficulty urinating
- Advanced age
- Anterior abdominal wall injuries (stabbing/gunshot)
What complaints do anterior abdominal wall hernias cause?
Swelling and pain are the most important complaints. The most notable complaint is swelling, which disappears by lying down or pressing on it. Sometimes pain may be the first symptom, but it is often accompanied by swelling. The most important factors that increase pain are heavy lifting, straining and standing for long periods of time.
If the organ coming out of the weakness in the anterior abdominal wall cannot return, that is, gets stuck in the hernia, and severe pain, nausea, vomiting and inability to defecate develop, this is called a strangulated hernia and requires urgent surgery.
How is the diagnosis made in anterior abdominal wall hernias?
Patients often consult a doctor because they feel swelling and sometimes pain in the abdominal area. The diagnosis is easily made with the information obtained from the patient, the history of the surgeries he has undergone, and the physical examination. In some cases, the diagnosis is confirmed by using imaging methods such as ultrasonography and computed tomography to determine the size of the hernia, which areas it covers, what is inside, and preparation for possible surgery.
How is the treatment performed for anterior abdominal wall hernias?
As with all hernias, the treatment of anterior abdominal wall hernias is to close the opening surgically and strengthen it with a synthetic patch. There is no treatment with a corset or any medical product.
What surgical techniques are used?
There are some issues that the surgeon should pay attention to before determining the type of surgery. The type of surgery is decided after evaluating the patient's age, existing diseases, medications used, the size of the hernia, the ratio of the abdominal wall and the hernia opening, whether the same hernia has been operated on before and whether there is an infection.
Open surgery
The area of weakness is reached through an incision made on the herniation. Then, the herniated organs and tissues are sent into the abdomen and the opening is closed with stitches and reinforced with a synthetic patch.
Laparoscopic surgery
It is performed with special devices placed through small incisions, usually on the opposite side of the herniation, at a distance where the hernia area can be seen and treated. The hernia is seen from the inside with a device called laparoscope, which has an optical imaging process. The organs and tissues in the hernia are pulled into the abdomen, and then the weakness in this area is repaired with a patch, with or without closing the opening. Since the incisions are smaller compared to the open method, it has the advantages of less pain and earlier return to normal life.
Robotic surgery
It is a procedure similar to laparoscopic surgery, but it provides convenience to the surgeon with 3D imaging. Using a platform away from the patient, the surgeon performs the surgery by directing special instruments placed on the patient as in laparoscopy.