hernias abdominalesAbdominal wall hernias are one of the most common pathologies encountered by a gastrointestinal surgeon in his/her daily practice. It is a defect of the abdominal wall through which a tissue or organ pushes through the abdominal cavity. There are many types of abdominal wall hernias, the most common are inguinal, umbilical and ventral hernias. It may be congenital or acquired.

 

1.Hiatal Hernia:

hernia del hiatoIt occurs when a portion of the stomach pushes through an opening in the diaphragm (the muscular layer that separates the chest from the abdomen and is used in breathing) and inside the chest cavity. The diaphragm becomes weakened by several factors:  aging, chronic cough, constipation, obesity, heavy object lifting, stress, or smoking.

 There are two types of hiatal hernias: The most common is the sliding hernia, where the gastroesophageal junction moves above the diaphragm together with a portion of the stomach; and the paraesophageal hernia, in which part of the stomach becomes herniated through the diaphragmatic hiatus without any movement of the gastroesophageal junction.

 

When symptoms caused by a hiatal hernia are so severe that are associated with chronic abdomen acid reflux, a surgical procedure known as Nissen Fundoplication is often recommended. It has very low rates of complications and recovery is quick. The procedure consists of a Laparoscopy where the upper or bottom part of the stomach is wrapped around the lower esophagus, thus preventing subsequent herniation and  gastroesophageal reflux.

 

 

 

2.Inguinal Hernias:

hernia_inginalInguinal hernias are lumps of fat covering the intestines or intraabdominal organs through the abdominal wall in the groin area. Clinically, the patient has pain and a small tumor that appears when standing and disappears when lying down.

 

Risk factors to develop hernias include lifting heavy objects either for work or sports reasons, smoking, family history of hernia, peritoneal dialysis patients, birth defect, after appendicitis, and prostate problems, and patients with abdominal aortic aneurysm.

 The indicated treatment is the placement of a mesh through laparoscopic technique. The surgery is an outpatient procedure (does not warrant hospitalization) in which small, almost imperceptible incisions in the abdomen are performed, significantly reducing the risk of infection, bruising, and rapid incorporation into daily activities is achieved within less than 15 days and athletes can begin lifting weight within 15 and 21 days.

 

3.Umbilical Hernias:

hernia umbilicalThe umbilical hernia is a bulge of fat covering the intestines or intra-abdominal organs that pushes through the navel scar. It is very common in children, adults and pregnant women. Children under the age of 5 and pregnant women should not be operated; if symptoms are present in the latter, they usually resolve after delivery.

Among the main risk factors are overweight, genetic alterations in connective tissue, infection, previous trauma surgeries. Laparoscopic surgery is an outpatient procedure under local or regional anesthesia (spinal). It is performed with a small incision at one edge of the umbilicus, the hernial sac is dissected and the wall defect is repaired with suture in special points. If the hernia is large, a piece of mesh is placed to reinforce the repair. Recovery is quick with little pain.