Abdominal wall hernia

1. Definition

An abdominal wall hernia is the abnormal protrusion of organs or tissues within the abdominal cavity through a congenitally or acquired weakened area of the abdominal wall fascia.

Abdominal wall hernias include:

• Anterior abdominal wall hernias: umbilical hernia, epigastric hernia, incisional hernia, and Spigelian hernia.
• Inguinal and femoral hernias.
• Pelvic hernias.
• Posterior abdominal wall hernias: lumbar hernias.

2. Risk factors

• Older age
• Strenuous physical activity or frequent heavy lifting
• Chronic obstructive pulmonary disease
• Difficulty urinating or straining to urinate due to benign prostatic hyperplasia, etc.
• Chronic constipation
• Pregnancy
• Abdominal tumors
• Overweight or obesity
• Previous abdominal surgery or trauma.

3. Symptoms

• Uncomplicated abdominal wall hernia:
• A bulge in the abdominal wall, usually appearing when there are factors that increase intra-abdominal pressure, such as heavy lifting, coughing, straining to urinate, or straining during bowel movements. The bulge may disappear when lying down or may be pushed back in manually. If there are no complications, the bulge is usually painless.
• Complicated abdominal wall hernia:
• In the case of an incarcerated hernia: the hernia cannot be pushed back in and is not painful.
• In the case of a strangulated hernia: the hernia cannot be pushed back in and is accompanied by pain at the hernia site. Some patients may develop symptoms of intestinal obstruction, including periumbilical abdominal pain, vomiting, inability to pass gas, and inability to have a bowel movement.
• In general, an abdominal hernia can be diagnosed based on medical history and physical examination without relying on additional diagnostic tests.

4. Diagnostic tests

Imaging helps accurately determine the location and size of the hernia defect, the blood supply to organs within the hernia sac, and the condition of the abdominal wall muscles and fascia.

• Ultrasound: A rapid and readily available method that provides an initial assessment of the hernia sac, herniated organs, the diameter of the hernia defect, etc.
• CT scan:
• Accurately assesses the location and size of the hernia sac, the herniated organ and its characteristics, the diameter of the hernia defect, the condition of the abdominal wall muscles, etc. This information helps determine an appropriate treatment plan.
• MRI: Used less frequently than CT scans and generally reserved for occult hernias or patients who cannot undergo CT scanning.

5. Complications

Incarcerated hernia: The herniated organ protrudes through the abdominal wall, cannot be pushed back in, and is not painful or associated with intestinal ischemia.

Strangulated hernia: The herniated organ protrudes through the abdominal wall, cannot be pushed back in, and causes pain and ischemia of the herniated organ, resulting in a surgical emergency.

6. Treatment

• Surgical repair of the abdominal wall with mesh placement is the gold standard for treating abdominal wall hernias.
• Mesh placement: There are generally four locations where mesh can be placed.
• Surgery can be performed using either laparoscopic or open surgery.
• Open surgery
• Laparoscopic surgery

7. Admission and treatment process

- Before surgery (day of admission):

• The treating physician will take the patient's medical history, perform a physical examination, and order relevant laboratory and diagnostic tests.
• Blood tests: creatinine, GOT, GPT, albumin, electrolytes, complete blood count, coagulation tests (PT, aPTT, fibrinogen), blood type, hepatitis B and C tests.
• Chest X-ray
• Abdominal ultrasound
• Abdominal CT scan or MRI if necessary
• Pre-anesthesia and perioperative assessments, consultations with relevant specialties (cardiology, endocrinology, respiratory medicine…), and preoperative rehabilitation and physical therapy assessment.
• The anesthesiologist will explain issues related to anesthesia.
• Surgery will be scheduled.
• The treating physician will explain the disease, treatment method, risks of adverse events and surgical complications, and obtain the patient's consent for surgery.
• Nurses will provide instructions on diet and medications that need to be discontinued, if any.
• The physician will mark the surgical site.

- Day of surgery:

• Usually on the second day after admission if there are no medical conditions requiring adjustment.
• Physical therapy on the morning of surgery.
• The patient will be transferred to the operating room area (2nd floor) when an operating room is available.
• Change into surgical attire.
• Enter the operating room.
• Anesthesia
• Surgery
• Transfer to the recovery room.
• Care in the recovery room: approximately 2–6 hours.
• Transfer to the surgical department once the condition is stable.

- After surgery:

• Patients are usually discharged 1–5 days after surgery, depending on the surgical method and the patient's condition.
• Common postoperative issues:
  • Nausea, vomiting, and dizziness due to the side effects of anesthetic medications
  • Surgical wound pain
  • Fever…
• Early mobilization and gentle walking are encouraged after surgery.
• Patients may drink bird's nest beverage and eat porridge 6 hours after surgery.
• Sutures are removed after 1 week–10 days.
• Follow-up and consultation with the surgeon 2–4 weeks after surgery.

8. Postoperative complications

Early complications:

• Side effects of anesthetic medications
• Medical complications: postoperative pneumonia, pulmonary embolism, cardiovascular complications, etc.
• Surgery-related complications: injury to intra-abdominal organs, early postoperative intestinal obstruction, surgical wound seroma, surgical wound hematoma, etc.

Late complications:

• Chronic postoperative pain
• Recurrent abdominal wall hernia

9. When should you call your doctor?

• High fever
• Severe abdominal pain
• Nausea and vomiting
• Abdominal distension
• Bleeding
• Persistent cough or difficulty breathing
• Swelling, redness, or pus from the surgical wound
• Inability to eat or drink
• Recurrence of the bulge
• Any questions or concerns related to your recovery.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.