There are several different types of hernias including ventral hernias, inguinal hernias, and hiatal hernias.
A ventral hernia is a defect in the abdominal wall. There are several layers to your abdominal wall and the hernia involves a weakening in the layers beneath the skin. This defect allows body organs like your intestines to protrude through the wall beneath the skin creating a bulge.
An inguinal hernia is also a defect in your abdominal wall but in the groin region. This is another place were intestines can protrude through the weakened spot. Hernias can cause pain and discomfort and can even become an emergency if bowel gets stuck in the hernia and causes an obstruction in the bowel where nothing can pass through, or the blood supply to the bowel gets cut off. While you may be able to see or feel a bulge in ventral and inguinal hernias, you cannot see a hiatal hernia.
A hiatal hernia is a hernia through your diaphragm. The diaphragm is a muscle that sits just below your lungs and helps you breathe as it contracts and relaxes. This muscle divides your chest cavity from your abdominal cavity. Everyone has a hole in their diaphragm that allows your esophagus to pass through and become the stomach just underneath the diaphragm. In a hiatal hernia, that hole is enlarged and allows your stomach to come up into your chest. This results in symptoms such as acid reflux and heartburn since your stomach is able to easily spit up acid into your esophagus.
Obesity impact
Obesity greatly increases the risk of developing a hernia. Having excess weight increases the strain and pressure on your abdominal wall muscles making them weaker, giving way to development of a ventral or inguinal hernia. Increased abdominal pressure can also push your stomach up through your diaphragm giving way to a hiatal hernia. The treatment for hernias is surgical repair of the weak spot so that the abdominal organs cannot push through. This can be done via sutures and/or mesh placed over the hernia.
Due to the increased risk of hernia development from obesity, it is very important to lose excess weight before a surgical repair; otherwise, there is a high risk the hernia will recur after surgery. One study found that hernia recurrence rate after surgical repair in an obese patient is 11%. That’s over 1 out of 10 patients that have a recurrence of the hernia after it has been surgically repaired. This study also looked at other variables for recurrence risks including age, gender, hernia size, and surgical technique; but, the only variable with any significant recurrence rate was obesity.
Therefore, hernia patients with a body mass index of 35 or greater should lose the excess weight BEFORE having a hernia surgery to greatly reduce the risk of a hernia recurrence and further surgery. Patient’s considering weight loss surgery to aid them in the process of losing weight should have weight loss surgery prior to the hernia surgery. In addition to obesity, incisions can also increase the risk of developing a hernia.
After a surgical incision is made, the tissue beneath is weakened, giving way to a hernia. Large open incisions are more likely to cause hernias than small incisions. At Roller Weight Loss and Advanced surgery, we perform our surgeries through small laparoscopic incisions the width of a pinky. In general, when undergoing surgery on the abdomen, it is always important to ask the surgeon if the procedure will be done laparoscopically and what the chance is that it will have to be converted to an open case.
Reference
1. Sauerland S., Korenkov M., Kleinen T., Arndt M., Paul A. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia. 2004 Feb; 8(1):42-6. Epub 2003 Sep 6.
