Hernias

A hernia is a tear or weakening in the body’s muscular wall that, if left untreated, may cause serious problems. Hernias are a common cause of intestinal obstruction and typically occur in the groin, abdomen and upper thigh. Hernias become noticeable when a "sac" of fat, tissue or intestine protrudes from the hernia defect. This often presents as a bulge or lump at the site. The bulge may vary in size and shape and can often be manually pushed back into its normal position. Though not all hernias cause discomfort, patients may report that strenuous activities such as heavy lifting will make the symptoms worse. If severe enough, even normal activities like sneezing, urination or having a bowel movement may cause pain.

Surgery is the recommended treatment for hernias. At Brigham and Women’s Hospital, hernia repairs are done by board certified general and gastrointestinal surgeons using minimally invasive laparoscopic techniques, which result in smaller incisions, less pain and a quicker recovery.

Hernia Topics

Types of Hernias

There are several types of hernias:

  • Abdominal Wall Hernias
    • Ventral/Incisional Hernias occur at the site of a surgical scar. The muscle that was held together by the previous sutures often weakens and yields a defect in the abdominal wall. These hernias can occur from months to years after the initial surgery. The surgical repair involves opening the old scar and reinforcing the abdominal wall, often with synthetic mesh material.
    • Umbilical Hernias commonly occur in children as a congenital defect, but can also develop in adulthood. Risk factors for umbilical hernias include obesity and prior pregnancy. These rarely develop into large defects but still should be repaired once discovered.
  • Groin Hernias
    • Inguinal Hernias happen when contents of the abdomen—usually fat or part of the small intestine—bulge through a weak point in the abdominal muscle. Men may notice a lump in the groin or scrotal swelling. Inguinal hernias can be congenital or acquired. Patients who are elderly, obese, or have chronic coughs or constipation are at increased risk. These should be repaired on an elective basis after detection, but patients should be aware of signs of incarceration or strangulation. Most patients who decide to wait ultimately have surgery within 10 years.
    • Femoral Hernias are more common in females and often present as a small bulge below the groin crease. These hernias tend to be small but have high rates of intestinal entrapment. These should be repaired quickly but not emergently, even if there are no symptoms.
  • Hiatal Hernias
    • Hiatal Hernias occur when the upper stomach slides into the chest through a small opening (hiatus) in the diaphragm. Hiatal hernias are common and often small and do not cause any significant problem to the patient. However, they can lead to symptoms including gastroesophageal reflux disease (GERD), heartburn, chest pain, swallowing and breathing problems.
    • Paraesophageal Hernias are a rare type of hiatal hernia in which a portion of the stomach pushes up into the chest adjacent to the esophagus. In cases of large paraesophageal hernias, other organs (e.g. colon, spleen) can be pushed up to the chest along with the stomach. Paraesophageal hernias are less common, but more concerning, because the blood supply to the stomach can be threatened and symptoms tend to be more severe.
Diagnosis of Hernias

General and gastrointestinal surgeons at Brigham and Women’s Hospital (BWH) utilize a range of procedures for diagnosing hernias:

  • Physical exam
  • Ultrasound
  • CT scan
  • Abdominal X-ray
Treatment for Hernias

Surgical Treatment

The surgical method used to repair a hernia depends on the type, size and location of the hernia. Brigham and Women’s Hospital general and gastrointestinal surgeons are experts in both surgical options:

  • Open Repair involves making an incision over the hernia site and pushing the bulging tissue or organ back in place. The surgeon closes the hole with sutures, or a combination of sutures and plastic mesh.
  • Laparoscopic Repair is a minimally invasive surgical procedure that uses small incisions, a tiny video camera, special surgical tools and a piece of plastic mesh to repair the hernia.
What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have a hernia and if surgery is needed. Careful monitoring and the involvement of an experienced general surgeon are important to the successful outcome for patients with hernia conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who have expertise in hernias. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by our experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience diagnosing and treating hernias. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Resources

Go to our health library to learn more about hernias.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

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