Spotlight on hernias

Jin Yoo, MD

Jin Yoo, MD

Hernias are common conditions that general surgeons see and treat on a daily basis. Surprisingly, they are often misunderstood from what they are and how they are treated from a public’s eye. A hernia is essentially a defect some place in the body where there shouldn’t be a defect. A defect may be a hole that shouldn’t be there (ventral/incisional hernias) or a hole that is naturally present but enlarged (hiatal, inguinal and parastomal hernias). Internal organs and intestines can traverse the defect and get partially or completely stuck, which can cause pain, or worse yet, strangulation of the internal organs that can lead to serious complications and even death. Therefore, if someone is diagnosed with a hernia, the general medical recommendation is to get it fixed unless the surgeon provides a compelling reason NOT to fix it. A common misunderstanding of hernias is that patients (and even some physicians) believe the hernia is the actual bulge the patient sees on the body, and they want this removed or cut out. Unfortunately, the bulge is actually the internal organ(s) that are bulging across the hernia defect, and therefore, that is not how hernias are treated. Hernias are fixed by correcting the defect.

What makes hernias even more complicated is that there are many types and they have their own special names. Here are some common hernias:

1) Inguinal hernia – this is a defect that arises from three potential sites in a person’s groin. Depending on the site, they are classified as indirect, direct or femoral.

2) Ventral hernia – this is a defect that arises on a person’s abdominal wall. Again, depending on the actual site and/or their cause, they are classified by names such as spigelian, incisional, epigastric and umbilical, to name a few.

3) Hiatal hernia – this is an enlargement of a naturally occurring hole in the diaphragm where the esophagus traverses from the chest into the abdomen before it turns into the stomach. The enlargement leads to the protrusion of the stomach up into the chest cavity resulting in reflux and obstructive symptoms when eating.

Again, the management of hernias is to surgically fix them as soon as a person is diagnosed with this condition UNLESS there is a compelling medical reason not to by the surgeon. Therefore, a surgical consultation is always recommended. The techniques by which hernias are fixed may drastically differ, but the general approach is to (1) put the “bulging” content back to its original location and to (2) fix the defect by closing up the hole or closing it down to its normal size.

To learn more about hernia surgery at Duke Regional, click here.

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