Surgical treatment of anterior abdominal wall hernias

An abdominal hernia is a protrusion of internal organs or fatty tissue through a defect in the musculoaponeurotic layer of the abdomen. It may occur in the area of the navel, along the midline of the abdomen, in the area of a postoperative scar, or in other anatomically weak areas.

A small abdominal hernia may cause no discomfort for a long time, but it does not disappear on its own and over time may increase in size or cause complications. Therefore, if a bulge appears on the abdomen, it is worth making an appointment with a doctor.

At Oxford Medical, patients with hernias are consulted by an experienced surgeon. At the clinic, you can undergo the necessary examinations and, if indicated, surgical treatment using modern minimally invasive techniques. You can make an appointment by phone or through the online appointment form website.

Hernias of the anterior abdominal wall differ primarily by the location where the defect forms. The following are distinguished:

• umbilical hernia — forms in the area of the umbilical ring;
• epigastric hernia — occurs along the midline of the abdomen between the navel and the sternum;
• Spigelian hernia — forms in the lateral part of the anterior abdominal wall;
• parastomal hernia — forms around a stoma;
• postoperative hernia — occurs in the area of a scar after a previously performed operation.

In addition to these, abdominal hernias also include inguinal hernia, femoral hernia, and other rarer types that differ in the anatomical location of the defect.

By origin, hernias may be primary or secondary — occurring after surgical intervention. Primary hernias include, in particular, umbilical and epigastric hernias, which form in anatomically weak areas of the abdominal wall.

An anterior abdominal wall hernia forms when the strength of the abdominal wall tissues decreases and intra-abdominal pressure regularly increases. In such a situation, organs or fatty tissue may gradually protrude through the weakened area.

Risk factors include:

• congenital weakness of connective tissue;
• age-related decrease in the elasticity of the muscles and aponeurosis;
• excess body weight and obesity;
• pregnancy;
• regular lifting of significant weight;
• chronic cough;
• prolonged constipation and frequent straining;
• previous operations on the abdominal organs;
• impaired healing of the postoperative wound.

Postoperative hernias more often form in the scar area, where the tissues have already been cut and sutured. The risk increases if healing was complicated by infection, significant tissue tension, or prolonged elevation of intra-abdominal pressure.

Possible complications include:

• incarceration of the hernia;
• intestinal obstruction;
• impaired blood supply to the incarcerated section of the intestine;
• inflammation or necrosis of tissues in the hernia sac.

The main danger of a hernia is associated with the risk of incarceration of its contents. In this case, the tissues that enter the hernia opening are compressed, and their blood supply is impaired. Without timely assistance, this may lead to necrosis and require urgent surgical intervention.

Doctors at Oxford Medical warn: if an abdominal wall hernia suddenly becomes painful, firm, can no longer be reduced, or nausea and vomiting appear, this may indicate incarceration. In such a situation, urgent medical attention is required.

In most cases, diagnosis begins with an examination by a surgeon. The doctor assesses the location and size of the bulge, checks whether it changes during coughing or straining, and also determines whether the hernia can be reduced.

If necessary, the following may be prescribed:

• ultrasound of the anterior abdominal wall;
• CT of the abdominal organs — if it is necessary to assess the size of the defect, the contents of the hernia sac, or anatomical features more accurately;
• laboratory tests and other examinations before planned surgery.

The results of ultrasound or CT complement the examination findings and help the surgeon assess the characteristics of the hernia more accurately before planning surgery.

The management approach depends on the type of hernia, its size, the presence of symptoms, and the risk of complications. If the defect is small and does not cause complaints, the doctor may recommend dynamic observation. However, an anterior abdominal wall hernia does not disappear on its own, so surgery is the main method of treatment.

During the intervention, the contents of the hernia sac are returned to the abdominal cavity, after which the defect is closed and the weakened area is reinforced. Depending on the size, location, and type of hernia, the operation is performed using an open or laparoscopic method.

In many cases, a mesh implant is used to strengthen the abdominal wall. It creates additional support for the tissues and helps reduce the risk of recurrent hernia formation.

Indications for planned surgery may include:

• gradual enlargement of the hernia;
• pain or persistent discomfort in the area of the bulge;
• limitation of physical activity;
• inability to reduce the hernia;
• increased risk of complications.

Doctors at Oxford Medical recommend consulting a surgeon if the hernia increases in size or begins to interfere with everyday life. This makes it possible to assess the condition of the defect and, if necessary, plan surgery before acute complications develop.

Removal of an abdominal hernia is performed under general anesthesia. In most cases, preference is given to the laparoscopic method — this is a minimally invasive intervention performed through several small punctures without a wide incision of the abdominal wall.

A miniature video camera and surgical instruments are inserted through the punctures. The image of the surgical area is transmitted to a monitor in an enlarged view, which allows the surgeon to clearly see the anatomical structures and accurately perform the necessary manipulations. After the contents of the hernia sac are returned to the abdominal cavity, the defect is closed. If necessary, the wall is reinforced with a mesh implant.

The open method is used if laparoscopic access is not suitable because of the size, location, or characteristics of the hernia. In this case, an incision is made in the area of the defect, through which the surgeon performs the main stages of the operation and restores the integrity of the abdominal wall.

After surgery, recovery proceeds gradually. During the first days, pain, swelling, and a feeling of tightness in the area of the intervention are possible. Their severity depends on the size of the hernia, the method of surgery, and the extent of abdominal wall reconstruction.

During the rehabilitation period, it is recommended to:

• care for the postoperative wound in accordance with the doctor's recommendations;
• take the prescribed medications;
• walk regularly and gradually increase daily activity;
• drink enough water and consume foods with fiber to prevent constipation and severe straining;
• temporarily avoid lifting heavy objects and performing intensive strength exercises.

Most patients return to light daily activity within the first few days, and to work without significant physical exertion — approximately after 1–3 weeks. Lifting weights, intensive training, and heavy physical work are usually restricted for approximately 4–6 weeks. After large or complex abdominal wall reconstructions, these periods may be longer, so the final recommendations are given by the surgeon during the follow-up examination.

The cost of surgical treatment of an anterior abdominal wall hernia depends on:

• the complexity of the operation and the need to install an endoprosthesis;
• the method of surgical intervention – laparoscopic or open access.

You can view the prices for operations at Oxford Medical here.

Only a surgeon can provide more precise guidance regarding the price, taking into account the diagnosis and other individual characteristics of the patient.