Lumber Disc Hernia Surgery & Abdominal Wall Hernias

They may originate from a weak area called the grynfelt triangle at the top or the petit triangle below.

Lumber Disc Hernia Surgery & Abdominal Wall Hernias

Abdominal wall hernias; It is the protrusion of organs or tissues in the abdomen from a weak point in the abdominal wall together with the hernia sac (peritoneum) and is one of the most common diseases treated in surgical clinics.
Factors such as cough, acid, obesity, pregnancy, BPH, malnutrition, smoking are the factors that facilitate the development of abdominal wall hernias.

Abdominal wall hernias; It is the protrusion of organs or tissues in the abdomen from a weak point in the abdominal wall together with the hernia sac (peritoneum) and is one of the most common diseases treated in surgical clinics.
Factors such as cough, acid, obesity, pregnancy, BPH, malnutrition, smoking are the factors that facilitate the development of abdominal wall hernias.

In the oldest methods used for the repair of abdominal wall hernias, it was tried to place the inguinal hernia in its place by hanging the patient upside down, and tools similar to the current (not recommended) inguinal ligaments were used to keep the hernia in place after placing it.

Classification of Abdominal Wall Hernia

Inguinal hernias : Inguinal and femoral

Anterior abdominal wall hernias : umbilical (navel), periumbilical (around umbilical), epigastric, spigel, supravesical, incision site

Lumbar region hernias : Upper (Grynfelt), Lower (Petit) and connected to the incision

Pelvic region hernias :  Obturator, Sciatica, Perineal

Complaints and Symptoms in Abdominal Wall Hernia

Hernia can exist for many years, or it may occur suddenly as complications of hernia such as intestinal obstruction or abdominal pain. The most common symptoms are pain and palpable swelling.
On examination, there is palpable swelling in the hernia area. In the examination, hernia swelling can be made more prominent by increasing the intra-abdominal pressure of the patient with maneuvers such as coughing and straining.

Inguinal Hernia

Inguinal region is the most common area of abdominal hernias and inguinal hernias are of two types, inguinal (direct and indirect) and femoral. Inguinal hernias are generally seen 25 times more in men. They are more common in the right groin. The most common are indirect inguinal hernias.

Femoral hernias constitute only 2.5% of all inguinal hernias, but the risk of compression in the canal and emergency surgery is higher. The treatment of inguinal hernias is surgical. Today, prosthetic materials known as patches are used in almost all surgical methods. Surgery can be performed open or closed (laparoscopic). Laparoscopic method should be preferred especially in bilateral inguinal hernias or in inguinal hernias that have been treated and recurred by applying a frontal patch.

UMBALIC (UMBLICAL) AND UMBILAL HERNIA (PERIUMBLICAL HERNIA)

It is more common in women, and complications such as compression within the hernia sac and related bowel obstruction may be common. Computed tomography may rarely be required for diagnosis in obese patients.

EPIGASTRIC HERNIA

Hernias located in the midline of the abdomen, between the navel below and the bone above, called the xiphoid.

  • Its incidence is 1 – 5%.
  •  It is more common in men
  •  They can be numerous
  •  Usually small and contains mostly adipose tissue
  •  The main complaint is a painful swelling. Sometimes hernias settled in this area can be confused with fat glands.

SPIEGEL HERNIA

  • Rare
  • It is more common in older women.
  • It occurs in the line next to the anterior abdominal wall muscles called the rectus and usually below the level of the navel.
  • Diagnosis is difficult with examination. Computed tomography and laparoscopy diagnostic
  • Its treatment is surgery. Surgery can be performed openly or laparoscopically.

Incision site (incisional) hernias

  • Hernia develops between 10-20% of the incision sites, especially after open surgeries.
  • Facilitating factors; bad technique, closure under pressure, infection, obesity, smoking, DM, COPD, hypoalbuminemia, suture material, other…
  • Treatment is surgery. In surgery, repair is most commonly performed using patches. Depending on the size of the surgical hernia and the type of previous surgery, it can be applied open or laparoscopically.
  • Repair without using a patch can only be preferred in patients smaller than 4 cm and without additional disease and obesity.

 PARASTOMAL HERNIA

  • It is a type of incision hernia.
  • The incidence is more than 50% in ostomies longer than five years.
  • More common in colostomies than ileostomies
  • Facilitating factors are the same as incision hernias
  • Its treatment is surgery. Surgery can be performed openly or laparoscopically. In both methods, the risk of recurrence is higher than other hernia types.

LOMBAR HERNIA

They may originate from a weak area called the grynfelt triangle at the top or the petit triangle below.

  • Generally, they may not show any symptoms other than an inconspicuous swelling and pain.
  • The risk of impingement and intestinal obstruction is low in these hernias.
  • Computed tomography is an important aid in diagnosis
  • Except for some of the incisions, the treatment is surgical.

PELVIC REGION HERNIA

  • Pelvic hernias are very rare. May occur in the obturator fossa, sciatic foramen and perineum
  • Obturator hernias are the most common.
  • It is generally seen in elderly and cachectic women.

Obturator Hernias

  • More common in women
  • Usually there is pelvic laxity
  • Clinic; Intermittent pain, pain in the anterior medial aspect of the thigh due to compression of the obturator nerve, mass present in vaginal or rectal examination
  • Preoperative diagnosis is difficult. It is absolutely necessary to use imaging methods.
  • High risk of blockage in the small intestine
  • The treatment is surgical, repair with a patch.
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