Abdominal hernia: what is it, types, surgery and postoperative period

• A hernia consists of a weakening of the abdominal wall, which causes a hernial sac covered by peritoneum to protrude through the weakened area.
• The definitive and most effective treatment to completely eliminate an abdominal hernia, whatever type it may be, is surgery, known as hernioplasty.
• During the postoperative period, the patient must take good care of the wound, rest and not carry out certain activities that may affect the wound.

An abdominal hernia occurs when there is a weakening in the wall of the abdomen. As a result of this weakening, a kind of sac, called a 'hernial sac', protrudes through the abdominal wall, which is usually part of an organ lined with peritoneum (the membrane that covers the organs of the abdomen). The organ that usually protrudes is the small intestine.

This protrusion is felt by the patient as a small, soft lump that, when pushed, pushes into the abdomen, but protrudes again when pressure is released.

Do you need umbilical hernia surgery?

Request a free and immediate appointment with our specialists

Make an appointment

Abdominal hernias, of whatever type, can have two different origins.

Firstly, the origin of an abdominal hernia may be congenital, i.e. the hernia may be present from birth due to a malformation of the abdominal wall of the foetus in the mother's womb, however, the hernia may not become visible until a few years later.

Secondly, abdominal hernia can also be incisional, i.e. it can arise due to previous surgical interventions in the abdominal area. Over the years, the internal surgical wound or suture may weaken and, as the patient tightens the abdomen, the hernia may find a suitable place to protrude.

Finally, thirdly, hernias can also be acquired. These are hernias that have been caused by excessive strain on the abdominal area, weakening of the abdominal wall due to ageing, health problems, etc. This group also includes incisional hernias.

In addition, risk factors that can lead to abdominal hernia include: chronic constipation, chronic coughing, enlarged prostate and consequent straining to urinate, being overweight, heavy lifting, overexertion, pregnancy, etc.

Types of abdominal hernia

Depending on the area in which they appear, hernias are called one way or another, although the cause of their appearance is the same. We classify abdominal hernias as follows:

• Inguinal hernia: as the name suggests, these are hernias that appear in the groyne area. The failure of the abdominal wall, in this case, occurs at the inguinal level. They mainly appear in men who do very heavy physical work or perform very intense physical activities. Inguinal hernia is common at any age and it should be noted that it is more common in men than in women.
• Femoral hernia: also called a crural hernia, it is located in the area near the groyne, although closer to the thigh. It appears as a bulge in the upper thigh, just below the groyne. This type of abdominal hernia is more common in women than in men.
• Umbilical hernia: this is a hernia that appears at or near the navel. It is common due to a congenital defect of the abdominal wall, as mentioned above. The umbilical hernia usually protrudes at the umbilicus, the place where the umbilical cord of the foetus was located before birth. The disappearance of the umbilical cord leaves a scar (what we know as the umbilicus), which can weaken over time and cause a failure of the abdominal wall, where the hernia protrudes through. Umbilical hernia is common in pregnant women, due to the pressure exerted on the abdomen.
• Epigastric hernia: this occurs in the upper abdomen, usually between the sternum and the navel. This type of hernia can occur, like the other hernias, due to overexertion in the abdominal area, such as: chronic coughing, constipation, lifting heavy objects, etc.

As we can see, there are different types of hernias that can arise due to the causes we have already discussed. To treat abdominal hernias and make them disappear completely, the only definitive solution is surgery.

The only treatment that completely removes an abdominal hernia is hernioplasty. This surgery removes the hernia and prevents it from recurring.

Hernioplasty is an outpatient procedure, which basically consists of reintroducing the hernia into the abdominal cavity and then placing a mesh of synthetic material in the operated area, which will prevent the hernia from protruding again.

Surgery to repair an abdominal hernia

Hernioplasty can be performed using two approaches, which are explained below:

Open surgery

In this surgery, the surgeon makes an incision in the area where the hernia is located, depending on the types of abdominal hernia explained above. This incision will allow the specialist to reach the hernia defect. Once the hernia defect has been found, the hernia defect is reinserted where it was originally located and the weakening of the abdominal wall is then closed with stitches.

The surgeon then places a synthetic mesh over the area where the abdominal wall was weakened. This mesh will strengthen the area and protect it, preventing the hernia from recurring. Finally, the specialist will suture the incision made with stitches and cover the wound with a dressing.

Laparoscopic approach

Abdominal hernia, wherever it is located, can also be surgically repaired by using the laparoscopic technique, which consists of making 3 or 4 small incisions in the patient's abdomen. 

A laparoscope (a long surgical instrument with a camera and light source at one end that allows the surgeon to see inside the patient's abdominal cavity on a monitor in the operating theatre) is inserted through one of these incisions. 

Through the other incisions, the surgeon inserts other tools that will allow him to operate on the patient comfortably and safely.

Once the procedure has been performed, the surgeon closes the wounds with stitches.

Both approaches are performed under general anaesthesia, and the procedure usually takes about 30-40 minutes due to its simplicity. However, its duration will depend on the severity of the hernia and its size.

Do you need umbilical hernia surgery?

Request a free and immediate appointment with our specialists

Make an appointment

Postoperative period after abdominal hernia surgery

As this is a relatively simple operation, the patient will be able to leave on their own feet on the day of the operation, although this is where the postoperative period begins.

It is normal for the patient to feel some discomfort or pain in the operated area after the operation, although this usually disappears with the intake of analgesic medication, which must be prescribed by the specialist.

Patients who have undergone abdominal hernia surgery should be careful and should also avoid physically demanding activities. Some of the activities that the patient should avoid are:

• Lifting heavy objects.
• Avoid sneezing or coughing loudly, as well as forced postures.
• Avoid driving a vehicle until instructed to do so by a specialist.
• Avoid constipation by eating a diet rich in fibre (vegetables, fruit, cereals).
• Avoid strenuous physical exercise.

Normally, the patient will be able to carry out light activities after the first week, and will be able to carry out the rest of the activities of daily life 4 weeks after the operation.

Abdominal hernia surgery is highly recommended for patients who suffer from this problem, as the symptoms will be completely eliminated and their quality of life will improve significantly, and they will be able to carry out activities that probably limited their daily life before.