Treating Hernias with Abdominal Wall Reconstruction
- 13 July 2016
- Dr. Nidal (Nick) Masri
It is very seldom that your plastic surgeon will recommend an abdominal wall reconstruction to you, as it is not considered to be a purely cosmetic procedure.
In fact, it is used not only to make your abdominal area look flat and toned, but also to repair and strengthen a weakened or damaged abdominal wall.
While there are several reasons why you should consider an abdominal wall reconstruction, perhaps the most common indication is the presence of hernias in your abdomen. Though it is not usually life-threatening, they still require surgery to prevent potentially dangerous complications.
Keep on reading to learn more about hernias and how they can be treated with abdominal wall reconstruction surgery.
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What is a hernia?
A hernia occurs when an organ or fatty tissue pushes through a weak spot in the muscle or tissue that holds it in place. Though it can appear in various areas of the body like the upper thighs and groin, it shows up most commonly in the abdomen.
These surrounding muscles and connective tissues--called fascia--that make up the abdominal wall can become weak due to pregnancy, weight gain, and constant strain. As a result, a portion of the bowel might protrude on the weak spot, hence causing a hernia.
There are various types of hernias, depending on their location. Some of the most common types include:
As the most prevalent type of abdominal hernia, inguinal hernias make up around 96 percent of all hernias. It occurs when the intestines push through a weak spot in the lower abdominal wall, often in the inguinal canal of the groin. It is more common among men because they have a natural weakness in that area.
A hiatal hernia happens when the upper stomach squeezes through the opening in the diaphragm where the esophagus passes from the chest into the abdomen. This can lead to serious complications, like the obstruction or twisting of the stomach.
In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. It is common among newborns, as well as women who have had many children or are obese.
Incisional hernias occur when the intestines push through the abdominal wall at the site of a previous abdominal surgery. This is common among elderly or overweight people who are inactive after getting an abdominal surgery.
Femoral hernias happen when the intestine pushes through the opening in the floor of the abdomen where the femoral artery and vein pass through to the leg. It tends to occur more frequently in women, especially those who are obese or pregnant.
What are the common causes of hernias?
Generally speaking, anything that causes an increase in pressure in the abdomen can cause a hernia. Examples of these include lifting heavy objects without stabilizing your abdominal muscles, pregnancy, diarrhea, constipation, damage from injury or surgery, and persistent coughing or sneezing. Obesity, poor nutrition, and smoking can also weaken muscles and increase your chances of getting hernia.
Age can also be a factor, as your abdominal muscles naturally weaken as you grow older. But even newborns can get a hernia congenitally when the abdominal wall fails to close properly in the womb as the baby grows and develops.
What are the symptoms of a hernia?
The most common symptom of a hernia is a bulge or lump in the affected area. You can feel this lump on either side of your pubic bone when you have an inguinal hernia. You may also experience a burning sensation or sharp pain in the area because of the inflammation of the inguinal nerve. There is also a feeling of fullness in the affected area when you do various activities.
Complications may occur when a piece of intestine becomes trapped in a hernia sac. That part of the bowel may swell and become cut off from its blood supply, causing a surgical emergency. Symptoms of an impending bowel obstruction include significant pain, nausea, and vomiting. A strangulated and dead bowel may even cause fever.
How is a hernia diagnosed?
Inguinal and incisional hernias can be diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.
Hernias that are more difficult to appreciate, such as hiatal and femoral, may require diagnostic procedures like a CT scan, barium x-ray, or endoscopy. To have a barium x-ray, you will be asked to drink a liquid solution containing barium that will show up on your x-ray images and help your doctor take x-ray pictures of your digestive tract. On the other hand, an endoscopy involves inserting a small camera attached to a tube down to your throat and stomach.
How is a hernia treated?
Hernias may not always require treatment, as it depends on its size and severity of symptoms. For some, dietary and lifestyle changes are enough to relieve its symptoms. Over-the-counter and prescription medications can also reduce acid reflux in a hiatal hernia and relieve discomfort.
However, if your hernia is causing you pain, you may need surgery to correct it. Inguinal hernia repair--also known as herniorrhaphy--is one of the most common surgical procedures performed in the United States, with almost one million operations occurring each year.
Another surgical option that is rising in popularity is abdominal wall reconstruction, which is commonly performed on patients with an incisional hernia post-bariatric surgery. In this surgery, the abdominal muscles are rearranged and repaired to improve the integrity of the abdominal wall, support its muscles, and protect the abdominal organs. Mesh may or may not be used to provide strength and reinforcement. Since it can also be a cosmetic procedure almost similar to a tummy tuck, abdominal wall reconstruction may be combined with liposuction to remove excess fat and hanging flaps of skin.
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