Hernia Diseases

What Is a Hernia?

A hernia is the protrusion of internal organs or fatty tissue as a result of weakening or tearing of muscles or connective tissue in an area of the body. Intestines or fatty tissue protruding through weak areas in the abdominal wall are noticed as a swelling under the skin.

A hernia develops through two main mechanisms:

• Congenital weakness: Failure of openings in the abdominal wall to close
• Acquired weakness: Weakening of the abdominal wall due to aging, heavy lifting, pregnancy, or surgery

Types of Hernia

Inguinal Hernia (Groin Hernia)

The most common type of hernia. It constitutes 75% of all hernias.

• 8-10 times more common in men than women
• Noticed as swelling in the groin area
• May progress toward the testicles in men
• Has two types: Direct and indirect inguinal hernia

Femoral Hernia (Thigh Hernia)

• More common in women
• Swelling in the upper thigh
• High risk of strangulation
• Requires early surgery

Umbilical Hernia (Navel Hernia)

• Hernia protruding from the navel area
• May be congenital in babies
• May develop in adults due to obesity or after pregnancy
• May close spontaneously in children up to 4-5 years of age

Epigastric Hernia

• Develops in the area between the navel and the breastbone
• Usually small fat tissue herniation
• Can be painful despite being small

Incisional Hernia

• Develops from a previous surgical incision site
• May be seen in 10-15% of those who have had abdominal surgery
• Can be wide and complex
• High recurrence rate

Spigelian Hernia

• A rare type of hernia in the lateral abdominal wall
• Often difficult to diagnose
• Requires surgical treatment

Hiatal Hernia (Stomach Hernia)

• Shifting of the stomach toward the chest cavity through the diaphragm opening
• Associated with reflux
• Surgery is required in some cases

Symptoms of Hernia

Typical Symptoms

• Swelling: Visible bulge in the affected area
• Pain: Throbbing or pulling pain in the area
• Discomfort: Especially increases when standing
• Burning or pressure sensation
• Swelling that disappears when lying down, appears when standing or straining

Symptoms That Increase With Activity

• Heavy lifting
• Coughing or sneezing
• Straining in the toilet
• Prolonged standing
• Exercise

Symptoms Requiring Urgent Intervention (Signs of Strangulation)

• Hardening of the swelling and inability to push it back
• Severe, persistent pain
• Nausea and vomiting
• Redness or bruising at the swelling site
• Abdominal distension and inability to pass gas
• Fever

These symptoms require urgent medical intervention.

Risk Factors

Factors that facilitate hernia development:

Congenital Factors

• Family history (genetic predisposition)
• Connective tissue diseases
• Congenital abdominal wall openings

Acquired Factors

• Age: Tissues weaken with advancing age
• Gender: Inguinal hernia is more common in men
• Excess weight and obesity
• Pregnancy and childbirth
• Chronic cough (COPD, smoking)
• Chronic constipation and straining
• Prostate enlargement (difficult urination)
• Heavy lifting (especially with wrong technique)
• Previous surgery history
• Conditions increasing intra-abdominal pressure
• Smoking (affects tissue healing)
• Inadequate nutrition

Diagnostic Methods

Physical Examination

The foundation of hernia diagnosis:

• Examination in standing and lying positions
• Evaluation during coughing or straining
• Checking the reducibility of the swelling
• Checking the opposite side as well

Imaging Methods

Ultrasound

• For detection of small or hidden hernias
• Radiation-free and safe
• Allows dynamic evaluation

Computed Tomography (CT)

• Detailed imaging in complex cases
• Evaluation of incisional hernias
• In strangulation suspicion

MRI

• For rare types such as Spigelian hernia
• In sports hernia diagnosis

Hernia Treatment

The definitive treatment for hernias is surgical. They do not heal on their own and may grow over time.

Watch-and-Wait Approach

Observation may be recommended in the following cases:

• Asymptomatic small hernias
• Patients with high surgical risk
• Umbilical hernia in babies (up to 4-5 years of age)

Open Surgery (Traditional Method)

• Classic incision method
• The hernia sac is opened, the content is repositioned
• The abdominal wall is repaired
• A mesh is usually used
• Can be performed with local, spinal, or general anesthesia
• Recovery time: 2-4 weeks

Lichtenstein Technique

The gold standard method in open inguinal hernia repair:

• A synthetic mesh is placed
• Low recurrence rate (1-3%)
• Can be performed under local anesthesia

Laparoscopic Surgery

Minimally invasive approach, currently the most preferred method:

• 3-4 small incisions (5-10 mm)
• Imaging with camera from inside the abdomen
• Mesh placement
• General anesthesia required
• Less pain
• Fast recovery (1-2 weeks)
• Smaller scars
• Treatment in a single session for bilateral hernias

TEP (Total Extraperitoneal) Method

• Performed without entering the abdomen
• Less complication risk

TAPP (Transabdominal Preperitoneal) Method

• Performed from inside the abdomen
• Preferred in complex cases

Robotic Surgery

• Advanced version of laparoscopic surgery
• Precise movement and imaging
• Advantageous in complex and recurrent hernias
• Less commonly used and more costly

Mesh Use

Mesh use is standard in modern hernia surgery:

• The abdominal wall is reinforced
• Recurrence rate is significantly reduced
• Various mesh types are available (polypropylene, biological)
• Easily accepted by the body

Post-Operative Process

First Days

• Mild pain and swelling are normal
• Managed with painkillers
• Wound should be kept clean
• Should not remain motionless, short walks are recommended

First Week

• Bathing according to physician recommendation
• Return to light activities is possible
• Driving after 1 week
• Sexual life after 2 weeks

First Month

• Return to work in laparoscopic surgery: 1-2 weeks
• Return to work in open surgery: 2-4 weeks
• Heavy lifting prohibited for 4-6 weeks
• Sports can start after 4-6 weeks

Long Term

• Full recovery in 6-12 weeks
• Lifestyle recommendations should be followed
• Regular check-ups

Possible Complications

Early-Stage Complications

• Bleeding
• Wound infection
• Hematoma (blood collection)
• Seroma (fluid collection)
• Difficulty urinating

Late-Stage Complications

• Chronic pain (2-5%)
• Hernia recurrence (1-3%)
• Nerve damage
• Mesh-related problems
• Testicular problems in men

Complications of Untreated Hernia

• Incarceration: Failure of hernia content to return
• Strangulation: Disruption of blood circulation
• Intestinal obstruction
• Intestinal necrosis (emergency surgery)
• Peritonitis (inflammation of the peritoneum)

Hernia Prevention

Lifestyle

• Healthy weight control
• Regular exercise (strengthening abdominal muscles)
• Smoking cessation
• Stress management

Correct Movement Techniques

• Bending knees when lifting heavy objects
• Keeping the load close to the body
• Avoiding excessive weights
• Correct posture

Nutrition

• Fiber-rich food consumption (prevents constipation)
• Adequate fluid intake
• Balanced nutrition

Medical Follow-Up

• Treatment of chronic cough
• Management of constipation
• Treatment of prostate problems
• Control of conditions increasing intra-abdominal pressure