Most inguinal hernias happen because an opening in the muscle wall does not close as it should before birth. That leaves a weak area in the belly muscle. Pressure on that area can cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in life.

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear all of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be painful, but some hernias cause a bulge without pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.

Sudden pain, nausea, and vomiting are signs that a part of your intestine may have become trapped in the hernia. Call your doctor if you have a hernia and have these symptoms.

Ventral Hernia

A ventral hernia is a bulge of tissues through an opening of weakness within your abdominal wall muscles. It can occur at any location on your abdominal wall.

Many are called incisional hernias because they form at the healed site of past surgical incisions. Here abdominal wall layers have become weak or thin, allowing for abdominal cavity contents to push through.

In a strangulated ventral hernia, intestinal tissue gets tightly caught within an opening in your abdominal wall. This tissue can’t be pushed back into your abdominal cavity, and its blood flow is cut off. This type of ventral hernia is an emergency requiring surgery.

Hernias can occur in other places of your body and are named after the location where they occur — for example, a femoral hernia occurs in your upper thigh.

Certain people are born with a congenital defect — one existing from birth — that causes their abdominal wall to be abnormally thin. They are at a greater risk for developing a ventral hernia. Other risk factors for a ventral hernia include:

  • pregnancy
  • obesity
  • History of previous hernias
  • History of abdominal surgeries
  • Injuries to your bowel area
  • Family history of hernias
  • Frequently lifting or pushing heavy objects

Umbilical Hernia

Umbilical hernias are very common in infants and young children, especially in babies born prematurely.

An umbilical hernia appears as a painless lump in or near the navel (belly button).

It may get bigger when laughing, coughing, crying or going to the toilet and may shrink when relaxing or lying down.

What causes an umbilical hernia?

During pregnancy, the umbilical cord passes through an opening in the baby's abdomen (tummy). This opening should close shortly after birth, but in some cases the muscles don't seal completely.

This leaves a weak spot in the surrounding muscle wall (abdominal wall). An umbilical hernia can develop when fatty tissue or a part of the bowel pokes through into an area near the navel.

In adults, factors that can contribute to developing an umbilical hernia include:

  • Being overweight or obese
  • Straining while moving or lifting heavy objects
  • Having a persistent heavy cough
  • Having a multiple pregnancy (such as twins or triplets)

Incisional Hernia

An Incisional Hernia is a hernia that occurs through a previously made incision in the abdominal wall, ie the scar left from a previous surgical operation.

The incision will have been made in order to get to an internal organ such as the appendix, or a caesarian section. So an Incisional hernia is not the same as a Recurrent Hernia.

After that previous operation, the surgeon will have had to close the layers of the abdominal wall with stitches. Sometimes this closure simply comes apart, fails to heal properly in the first place or just comes apart with time.

It is common to have adhesions that fix abdominal contents within the hernia sac. This makes the hernia an incarcerated hernia. A hernia does not get better over time, nor will it go away by itself. Complications of incisional hernias such as incarceration, strangulation and obstruction do occur.

If a hernia develops in the abdomen and the patient has not had surgery, it is not an incisional hernia. A patient who gains significant weight after an abdominal surgery, becomes pregnant, or participates in activities that increase abdominal pressure (like heavy lifting) is most at risk for an incisional hernia.

In 1993, LeBlanc reported the first case of laparoscopic incisional hernia repair with the use of synthetic mesh. The procedure involves the placement of a mesh inside the abdomen without abdominal wall reconstruction. The mesh is fixed with sutures, staples, or tacks

Lumbar Hernia

Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option.

A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome.

A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach