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Abdominal wall hernia is an extra-abdominal hernia that occurs in the abdominal wall. It is a general term for extra-abdominal hernia except for inguinal hernia and femoral hernia. Inguinal hernias account for about 15% of all external abdominal hernias, and although less in number than inguinal hernias, the condition and treatment are more complicated than the most common inguinal hernias. As with all extra-abdominal hernias, patients have congenital or acquired abdominal wall defects or weakness, and organs such as intestines in the abdominal cavity protrude to the surface through the defect.

Basic Information

English name: Abdominal Hernia
English alias
Visiting department: General Surgery
Common locations: abdomen
Common causes: Congenital: Local tissue developmental defect in the abdominal wall; Acquired: Poor healing of the surgical incision, reduced abdominal wall strength, increased intra-abdominal pressure, etc.

Common symptoms: The abdomen wall sometimes appears absent, and sometimes small and large; there is no significant discomfort in the early stage, and the tumor gradually grows with the course of the disease, with abdominal distension, intestinal adhesions, intestinal obstruction, etc.

Causes of abdominal wall hernia

The causes of abdominal wall hernias include both congenital and acquired aspects. The most common congenital factors are the developmental defects of the local tissue of the abdominal wall. For example, patients with umbilical hernia usually have larger umbilical rings, patients with white line hernia often have defects on white line fibers, and lumbar hernias often have congenital weakness of the lumbar triangle. Acquired factors mainly include three major factors: poor healing of the surgical incision, decreased strength of the abdominal wall, and increased intra-abdominal pressure. For example, patients with incisional hernias often suffer from poor healing of the incision after surgery, and the abdominal wall strength of women is relatively low and more likely to occur; multiple pregnancy Or the fetus is too large, causing the umbilical ring to widen, which leads to the occurrence of umbilical hernia. Factors such as increased intra-abdominal pressure such as ascites can also cause umbilical hernia. Obese people are also prone to incision hernia and parastoma, which may be related to high intraabdominal pressure and fat Prone to postoperative incision is not easy to heal and related to incision infection.

Clinical manifestations of abdominal wall hernia

1. Characteristic clinical manifestationssometimes absent or absent when the abdominal wall appears. The mass appears or becomes larger when standing and increasing abdominal pressure, and in the early stages of supine, it can disappear by itself or by hand, or it becomes smaller. In addition to the early manifestations of the patients, the patients had no significant discomfort.

2. As the course of the disease increases, the mass will gradually increase with the enlargement of the defect, and the patient will also experience gastrointestinal symptoms such as abdominal distension and abdominal discomfort. Such symptoms will improve after lying flat. Some patients have adhesions due to the contents of the hernia to the hernia sac and hernia ring, and the mass can no longer disappear and persist. Some patients will experience symptoms of intestinal adhesions and intestinal obstruction. Individual patients may have incarceration due to a sudden increase in abdominal pressure. If they are not handled in time, serious conditions such as strangulation, intestinal necrosis, and even death may result.

3. Patients with incisional hernias often have a history of poor healing of abdominal surgical incisions. Later, the original incision on the abdominal wall shows characteristic tumor masses.

Abdominal wall hernia

A typical sign is a mass with a change in size on the abdominal wall, which disappears when the patient is lying flat in the early days, but can appear when standing or exerting force. B-ultrasound and CT imaging examinations can be used as auxiliary diagnostic measures.

Diagnosis of abdominal wall hernia

A simple and typical abdominal wall hernia can be clearly diagnosed by asking a detailed medical history and careful physical examination, but for patients with atypical abdominal wall hernia, relevant imaging studies are needed to assist the diagnosis. CT and so on are of great help in determining the size of the defect.

Abdominal Wall Hernia Treatment

Treatment principle: Except for congenital umbilical hernia within one year of age, most patients need to be treated, mainly surgical treatment. Surgery is the only effective way to cure most abdominal wall hernias.

Non-surgical treatment

(1) Congenital umbilical hernias in infants and young children under the age of one year can be clinically observed. If they are not healed over one year old, surgery can be considered.

(2) Abdominal band: For patients without surgical conditions or patients waiting for surgery, the abdominal band can be used for life or temporarily. The use of an abdominal band can avoid the rapid expansion of the defect and the prolapse of the hernia contents, and can avoid incarceration. However, for patients whose hernia contents are difficult to receive in the hernia sac, the abdominal band should be used with caution to avoid improper compression of the contents of the intestine and other contents by the abdominal band.

2. Surgical treatment

The surgical methods of abdominal wall hernias are different for different ages and conditions. The following is only an overview. For details, see the contents of each subordinate entry. There is a difference in the surgical treatment methods for children and adults. Children mainly do local tissue suture repair, and do not use synthetic patches. Adults often use patches and other materials for repair operations.

(1) Tissue suture repair Tissue suture repair is a method of repairing the defect by suture closure on both sides of the defect. It is mostly used for small abdominal wall hernias with small defects (defects less than 2 to 3 cm), and pediatric hernias that are not suitable for patch repair. Tissue suture repair, other cases using this method also include wound infection or severe contamination of the abdominal wall hernia repair. Tissue suture repair varies according to the specific condition of the abdominal wall hernia. For example, small white line hernias and semilunar hernias can be directly closed. Umbilical hernias can be folded and sutured. White line hernias can be opened with an anterior rectus sheath. After the reduction of sutures, the incision hernia at the midline position can use the technique of abdominal wall component separation and so on.

2. Patch repair At present, the repair of abdominal wall hernia by using materials is the main method of surgical treatment. For medium-sized or larger abdominal wall hernias, material repair is preferred. The applied materials are clinically called patches. Patch repair methods are also various. It can be divided into open repair and laparoscopic repair according to the surgical repair method; according to the placement of the patch, it can be divided into repair above the defect (Onlay), posterior peritoneum (Sublay) and posterior defect intraperitoneal (IPOM) repair; according to whether the abdominal wall hernia defect The meaning of closing the patch repair is divided into bridge repair (do not close the defect) and enhanced repair (close the defect). The repair of abdominal wall hernia is different from the repair of inguinal hernia. The tension-free repair is not emphasized clinically.

Laparoscopic abdominal wall hernia repair does not make an incision in the abdominal wall. The operation is completed through 3 to 5 puncture holes, which has little trauma to the patient and the patient recovers quickly after the operation. However, anti-adhesion patches and laparoscopic equipment are required, which is costly and is costly. The doctor's operation requirements are also high. For most incisional hernias, parastomas, and semilunar hernias, laparoscopic patch repair is preferred. Primary lumbar hernias and small white line hernias are easier and more convenient with open sublay surgery; for umbilical hernias, laparoscopic IPOM repair or open sublay are options.

Abdominal wall hernia prevention

White line hernia, semilunar hernia, and primary lumbar hernia mostly have congenital local defects, which occur with the decrease of abdominal wall strength and / or the increase of intra-abdominal pressure as the patient ages, which is difficult to prevent. Umbilical hernias are also partly caused by congenital factors. In addition, women with obesity and multiple pregnancies are more frequent, and patients with cirrhosis and ascites are also prone to occur. Therefore, avoiding an oversized fetus during pregnancy and controlling ascites in patients with cirrhosis are important suture measures. The occurrence of incisional hernias is mostly related to poor incision healing after abdominal surgery. Reducing poor incisional healing can help prevent incisional hernias.