The abdominal wall is composed of muscle and fascia, a tough fibrous material. Together these tissues support the skeleton and allow movement, but ALSO contain and protect the intraabdominal organs. During our daily activities, when we are upright, the abdominal wall must resist gravity forces on the intraabdominal and freely moveable bowel and omentum, a fatty apron-like structure that hangs down in front of the bowel. If there is a defect present in the wall, these contents can bulge out. Over time, the defect may be progressively stretched and enlarged, resulting in a larger bulge, and more fat or bowel pushing through the defect.
This defect cannot “heal” itself, and cannot be corrected through exercise. Although the growth rate may be slow and unpredictable, most such hernias will enlarge over time. Contrary to popular belief, uncomplicated hernias usually cause little true pain—but may be associated with a sensation of heaviness or fullness. Not surprisingly, these symptoms may be more noticeable and troublesome after prolonged standing and/or physical activities. Many inguinal (groin) hernias are occult and silent, and only diagnosed at the time of a routine physical exam for school or work.
Once diagnosed, most hernias should be evaluated by an experienced Board Certified surgeon who is fully trained in the evaluation and repair, if indicated, of abdominal wall hernias. Preferably, this surgeon should be comfortable and confident in the use of both traditional “open” techniques (using a standard incision to address the hernia) and minimally invasive laparoscopic techniques (using small tubes to introduce a camera and instruments) to repair the hernia. Only an experienced hernia surgeon can determine which repair technique is best suited for any particular presentation. Almost always some type of patch material is used to repair and reinforce the weakened wall. Different materials are available, and each repair must be assessed to determine which material is best suited to that specific repair. Although with any hernia repair there is a risk of recurrence, this risk can be kept to a minimum by an experienced surgeon, using optimal techniques, equipment, and materials.