Hernias

Hernias are protrusions of an organ or tissue through an opening or weak spot in the surrounding muscle or connective tissue. They most commonly involve the abdominal wall but can occur at other sites. The principal types are inguinal (in the groin), femoral (below the groin), umbilical (around the navel), incisional (at the site of a previous surgical incision), and hiatal (through the diaphragm into the chest). Inguinal hernias may be direct or indirect, reflecting different anatomical pathways.

Causes and risk factors include congenital weakness, increased intra-abdominal pressure from heavy lifting, coughing, obesity, pregnancy, or prior surgery. Hernias may be asymptomatic or cause a lump that may be more noticeable with coughing or standing and reduce when lying down. Pain, fullness, and pressure can occur. Complications such as incarceration (strangulation) of the herniated content require urgent treatment.

Diagnosis is typically based on history and physical examination. Imaging such as ultrasound, CT, or MRI may be used if the diagnosis is uncertain or to plan repair.

Treatment is usually surgical. Watchful waiting may be considered for select small, asymptomatic inguinal hernias in some patients, but many adults with symptomatic or enlarging hernias undergo repair to prevent complications. Open repair with mesh reinforcement and laparoscopic techniques (such as transabdominal or totally extraperitoneal repair) are common. Hiatal hernias may require repair of the diaphragmatic defect and, for reflux symptoms, a fundoplication.

Prognosis is generally good after repair, but recurrence, infection, or chronic pain can occur. Prevention focuses on avoiding activities that excessively raise abdominal pressure, maintaining a healthy weight, and managing chronic cough or constipation.