A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding

muscle or connective tissue called fascia. The most common types of hernia are inguinal
(inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly
button), and hiatal (upper stomach).
In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or
into the inguinal canal in the groin. About 80% of all hernias are inguinal, and most occur in
men because of a natural weakness in this area.
In an incisional hernia, the intestine pushes through the abdominal wall at the site of
previous abdominal surgery. This type is most common in elderly or overweight people who
are inactive after abdominal surgery.
A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into
the upper thigh. Femoral hernias are most common in women, especially those who are
pregnant or obese.
In an umbilical hernia, part of the small intestine passes through the abdominal wall near the
navel. Common in newborns, it also commonly afflicts obese women or those who have had
many children.

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Although abdominal hernias can be present at birth, others develop later in life. Some involve
pathways formed during fetal development, existing openings in the abdominal cavity, or
areas of abdominal wall weakness.
Any condition that increases the pressure of the abdominal cavity may contribute to the
formation or worsening of a hernia. Examples include:
obesity,
heavy lifting,
coughing,
straining during a bowel movement or urination,
chronic lung disease, and
fluid in the abdominal cavity.

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The signs and symptoms of a hernia can range from noticing a painless lump to the severely
painful, tender, swollen protrusion of tissue that you are unable to push back into the
abdomen (an incarcerated strangulated hernia).

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 It may appear as a new lump in the groin or other abdominal area.

It may ache but is not tender when touched.
Sometimes pain precedes the discovery of the lump.
The lump increases in size when standing or when abdominal pressure is increased (such
as coughing).
It may be reduced (pushed back into the abdomen) unless very large.

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 It may be an occasionally painful enlargement of a previously reducible hernia that cannot

be returned into the abdominal cavity on its own or when you push it.
Some may be chronic (occur over a long term) without pain.
An irreducible hernia is also known as an incarcerated hernia.
It can lead to strangulation (blood supply being cut off to tissue in the hernia).
Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

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 This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel
obstruction (nausea and vomiting).
The affected person may appear ill with or without fever.
This condition is a surgical emergency.

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Treatment of a hernia depends on whether it is reducible or irreducible and possibly

strangulated.

Reducible hernia
In general, all hernias should be repaired to avoid the possibility of future intestinal
strangulation.
If you have preexisting medical conditions that would make surgery unsafe, your doctor
may not repair your hernia but will watch it closely.
Some hernias have or develop very large openings in the abdominal wall, and closing the
opening is complicated because of their large size.
The treatment of every hernia is individualized, and a discussion of the risks and benefits
of surgical versus nonsurgical management needs to take place between the doctor and
patient.

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Irreducible hernia
All acutely irreducible hernias need emergency treatment because of the risk of
strangulation.
An attempt to reduce (push back) the hernia will generally be made, often after giving
medicine for pain and muscle relaxation.

In cases in which the hernia has been strangulated for an extended time, surgery is
performed to check whether the intestinal tissue has died and to repair the hernia.
In cases in which the length of time that the hernia was irreducible was short and
gangrenous bowel is not suspected, you may be discharged from the hospital.
If a hernia that appears irreducible is finally reduced, it is important to consider a surgical
correction. These hernias have a significantly higher risk of getting incarcerated again.

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Dr. Satish Pattanshetti

M.S ( Gen. Surg ) , F M A S
Fellowship in Bariatric and Metabolic Surgery (Taiwan)
Consulting Laparoscopic & General Surgeon
Bariatric & Metabolic Surgeon
Specialist in Single port Laparoscopic Surgery

Dr. Neeraj V Rayate

Director and Principal Surgeon
Dr Neeraj Rayate is a GI and General surgeon with expertise is laparoscopic and robotic surgery for
gastro-intestinal diseases and bariatric surgery. After completing his medical education in India. He has
also completed a fellowship in Gynecological Endoscopy from the Giessen School of Endoscopic Surgery
in Germany. Dr. Rayate has special interest in Hepatopancreatobiliary surgery and gynecolological
oncology.

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