Hernias are hereditary or acquired defects of the abdominal wall such as the umbilical region, the inguinal area and others. Mostly we find as a reason a weakness of supportive tissues which are giving way step by step and as a consequence structures of the abdominal cavity are allowed to move outside and to cause painful swellings, which are frequently visible on the body surface. Rarely hernias are dangerous. However, frequently they continue to enlarge and can sometimes cause incarceration, which can occasionally lead to bowel perforation and/or abdominal infection.
According to the region, we distinguish the following hernias:
Inguinal hernia in children (mostly boys)
Those hernias are always inherited and caused by the lack of closing of the peritoneal layers behind the descending testes during maternal child-development. Frequently, they can be caused by extreme straining of the inguinal region. Inguinal hernias are usually painful and have a tendency to enlarge over time. They should be closed to avoid later complications such as small bowel occlusion.
Incisional hernias (after operations)
Very frequent indications which can occur after complex abdominal operations with secondary infections. They occur usually 3 to 6 months after the primary operation and enlarge over time. Those hernias with increasing size are more difficult to close. Frequently, artificial material has to be implanted to replace the enlarged abdominal wall and to reduce the risk of recurrence.
Umbilical hernias
Those hernias are frequently inborn and rarely caused by ascites formation due to liver functional impairment. Care should be taken if the umbilical hernia occur in the context of a liver disease such as liver cirrhosis. In this condition the primary liver disease should be treated first (for example: liver transplantation) before the hernia is closed, because dangerous dehiscence with secondary abdominal infection and chronic fistulae can develop.
Otherwise those hernias are easy to treat and should be closed to avoid bowel incarceration.
Sub inguinal hernias
Frequently present in elderly people (mostly women). Those hernias develop by protrusion of the abdominal content below the inguinal ligament and they buldge-out the upper part of the thigh below the usual site of inguinal hernias. They also should be closed because they have a high tendency for bowel incarceration.
Inner hernias
Those hernias are rare and usually caused by previous operations inside the abdomen. They can also cause small bowel obstructions and strangulation with the consequence of small bowel hypoperfusion. They should be closed if they are symptomatic.
Diaphragmatic hernia
Those hernias sometimes occur after serious traffic accidents or as a consequence of direct trauma with sudden pressure increase with in the abdomen upon impact. Frequently, however they are acquired and caused by increasing dilation of the natural entry sites through the diaphragm (for example: the gastroesophageal junction).