Abdominal Wall

What is an Abdominal Hernia?

Ventral (abdominal wall) hernias occur when there is a weakening in the abdominal wall. This may be a result of prior surgery or can occur spontaneously in the case of umbilical, epigastric, Spigelian hernias. Incisional hernias occur when the fascial tissues do not completely heal after previous surgery. Risk factors include infection, immunosuppressive medications, poor nutrition, connective tissue disorders, obesity, smoking, and emergency surgery. Some patients complain of a bulge in the abdominal wall or mild discomfort. A lumbar hernia technically is outside of the abdominal wall. It occurs between the lower edge of the ribs and the hip bone. A lumbar hernia is most often related to a previous surgery in the area such as removing a kidney. Some people with lumbar hernias complain of pain or a buldge that is worse with coughing or straining.

Other types of abdominal wall hernias include umbilical hernias, epigastric hernias, Richter’s hernias, and Spigelian hernias. An umbilical hernia is when there is a soft defect or bulge at the belly button. These can be present at birth or become more noticeable later in life. Repair is generally reserved for patients over 3 years of age. If tissue is trapped in the defect, you need to have this evaluated to make sure that it is not bowel. An epigastric hernia refers to the location of the hernia. This hernia occurs between the bottom of the breast bone (xiphoid process) and the top of the umbilicus. Most patients notice a small lump in the area. If the area is tender, then it should be repaired. A Richter’s hernia is when a small portion of the bowel is trapped in the hernia defect. The blood supply becomes compromised to the knuckle of bowel which can progress to bowel ischemia and sometimes gangrene. This is a surgical emergency. A Spigelian hernia is when there is a defect on the edge of the abdominal muscles. An ultrasound can often confirm diagnosis.

Diastasis Recti is another condition where there is central weakening of the midline muscle that is more evident on straining or doing a sit up. The central portion of the abdominal wall is called the fascia. It is normally 1-2 mm but can become larger with body habitus or pregnancy. Since the fascia is thin but still intact, there is no risk of bowel compromise.

In any type of hernia, you should seek care immediately if the skin is red or discolored over the area of concern or if you have signs of obstruction such as nausea, vomiting, failure to pass flatus or stool.

How Can We Help?

We can evaluate all hernias and determine if surgery is appropriate for you. Most incisional hernias should be repaired to reduce the risk of bowel getting trapped in the defect. If the hernia is small, it may be repaired in an open fashion with suture. If the hernia is larger, it can be repaired laparoscopically or in an open fashion with mesh. Most hernia repairs are outpatient procedures. A lumbar hernia can be repaired laparoscopically or by open technique. Mesh is almost always used. Most people are admitted to the hospital following surgery for pain control.

Umbilical hernias are usually repaired with a small incision. Sometimes they are repaired at the time of another scheduled abdominal surgery. Depending on the size and tension, mesh may be used. An umbilical hernia repair is most often an outpatient surgery. If a patient has an asymptomatic umbilical hernia and excess fluid in the abdomen (ascites) then surgery is not usually recommended. The repair for an epigastric hernia is similar to an umbilical hernia repair. A Richter’s hernia needs to be repaired and a bowel resection is often required. It is recommended to have a Spigelian hernia repaired once the diagnosis is made to prevent bowel getting trapped in the defect. It can be repaired open or laparoscopically. If the hernia is small, it is an outpatient procedure.

The treatment for diastasis recti can include weight loss and exercise programs. If it is a result of pregnancy, the area can be tightened once pre-pregnancy weight is achieved and there are no plans for future pregnancies. Diastasis recti repair is often performed by a plastic surgeon.

Who to Contact

Dr. Charlie Jones and Dr. Susan Hagen are general, vascular and thoracic surgeons with over 30 years of experience. To make an appointment, please call 303-443-2123.