Complex Abdominal Hernias

Mr Charles Imber offers expert abdominal surgery. The operations that he performs can treat a variety of conditions that affect the organs inside the abdomen (pancreas, gallbladder, liver, spleen, small and large intestine) or the abdominal wall (hernias).

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Complex abdominal hernias

While many abdominal hernias are simple and easily treated with an open/laparoscopic hernia repair, a few are more complex. They include:

Incisional hernias in which the intestine pushes through a body wall weakened by previous hernia surgery, sometimes in several places. In some incisional hernias, the original wound has only partially healed. Some of the intestine can become trapped in the scar tissue.

Strangulated hernia

Very large hernias that are due to general weakness in the abdominal wall, making standard repair techniques difficult

Hernias that recur repeatedly despite surgical repair

Infected hernias, including infection in the region of a hernia repair

Infection in the mesh used to repair some larger hernias

Complex infected wounds with fistulae: The intestine ruptures and releases the contents of the bowel into the wound, which gets larger and will not heal.

Hernia symptons

The commonest thing to notice is a pain in the groin or a small lump. It is often more noticeable with an increase in intra-abdominal pressure such as when coughing, sneezing or straining. If the hernia suddenly becomes more painful or larger urgent medical advice is required as this can suggest strangulation, these are the normal Hernia symptoms.

What is an abdominal hernia?

The lump that appears if you have a hernia is a portion of your intestine poking through a weakness in the body wall. A weak spot can appear anywhere and is due to separation or tearing of the sheet of muscle that protects the abdominal organs. The lump usually goes back in when gentle pressure is applied – that’s a reducible hernia. Sometimes hernias don’t go back into the abdomen at all – that’s a non-reducible hernia.

What causes a hernia?

Hernias have many different causes but lifestyle plays an important part. You are more likely to develop a hernia if you are:

• Male
• Overweight or obese
• Often constipated
• A smoker and you have a smoker’s cough
• A woman who has had several pregnancies
• A manual worker who often has to do heavy lifting.

Common types of abdominal hernia

The basic underlying cause of any hernia is the same but different types of hernia are recognised according to where they occur and what triggers them.

Inguinal hernias: These develop along a line of weakness through the muscle in the groin. This channel is the inguinal canal and a hernia here is more likely in men as the tubes that run from the testicles pass near here. About three-quarters of all hernias are inguinal and in every 100 people diagnosed with an inguinal hernia, 96 will be men and only four will be women.

Femoral hernias: These also arise in the groin but are generally rare. They are more likely to develop in women than men and are also more prone to complications.

Umbilical hernias: These develop at weak points in the muscle underlying the umbilicus – the belly button. This type of hernia can develop in babies shortly after birth but usually get better on their own. Adults can also get them, but need treatment as they tend to get worse over time.

Midline hernias: This term is used to describe a hernia on the front part of the abdomen that is not associated with the belly button.

Incisional hernias: Whenever the body wall is cut, such as if you have had an open appendix operation or a Caesarean section during childbirth, the healed scar is never as strong as the original body wall. Hernias are common along incision lines and can be one of the most difficult hernias to repair.

Many of the more serious types of complex abdominal hernia were inoperable only a few years ago. The only treatment available for a large and complex hernia was to wear a supportive medical corset to hold the internal organs in place.

Now we have new techniques and technologies that make it possible to not only repair the hernia and prevent it from recurring again, but the tissues that have been damaged can also be reconstructed.

Living with a complex hernia

If someone with a complex hernia does not have access to a specialist surgeon with experience in treating difficult cases, they may lose much of their quality of life.

Complex hernias can be very painful but they are also disfiguring, embarrassing and restrict movement and everyday activities. Not only are you often not able to work, go out or see your family, having any sort of social life becomes difficult.

Treatment challenges in complex hernias

Large hernias: small hernias are easy to repair using the body’s own tissues to strengthen the underlying weakness in the muscles of the body wall. Surgical or biological mesh needs to be used to repair larger hernias, particularly if the patient is overweight or obese.

Strangulated hernias: Once a hernia lump becomes trapped in the body wall, it can become inflamed and infected. Repairing the hernia also means removing the part of the intestine that has been damaged and joining up the healthy ends.

Infected incisional hernias: Any complex hernia in which there is a chronic infection poses a great challenge for surgical repair. There is a danger that the infection will spread into the rest of the body through the blood, and a risk that any surgical mesh that is used will become the site of a local infection.

Infection in a hernia mesh repair: Again there is a risk of spreading the infection, but an infected mesh needs to be removed and cannot be replaced by new synthetic mesh. Reconstructive surgery to repair the body wall using the patient’s own tissues and the use of more expensive biological meshes is then needed as they are more resistant to future infection.