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The abdomen is a large, muscular sack that contains the internal organs. If an abnormal opening occurs in the usually strong muscular wall, the internal organs can bulge out. This bulge is called a hernia. An incisional hernia is a tear or weakness in the muscular abdominal wall at the site of a previous surgical incision. During open abdominal operations an opening is made in the muscle layers that is closed with stitches. Scar tissue gradually forms creating a bond between the two sides of the incision. This scar tissue connection is never as strong as normal tissue and can tear or give way under a variety of conditions. When the scar tissue gives way, an incisional hernia is the result.
Hernias frequently occur at the umbilicus, also called the navel or belly button. The tissues in this area are naturally weak since it is largely scar tissue that closed the opening where the umbilical cord was cut at birth. This type of hernia often causes the umbilicus to protrude out and in some patients is even visible through their clothing. In newborns, umbilical hernias may actually close by about age 5, but hernias in older children and adults will never close by themselves.
Some hernias cause no symptoms at all, but most patients describe:
dull aching sensation
fullness in the abdomen
If a loop of intestine pushes its way out through a hernia it may become trapped, leading to an intestinal blockage. This situation, known as an incarcerated hernia, needs to be treated right away to avoid strangulation and gangrene of the intestine.
To repair an incisional or umbilical hernia requires an operation to close the opening in the muscular layer of the abdomen. Umbilical hernias can often be repaired directly through an incision in or near the umbilicus. A reinforcing sheet of mesh may be used to strengthen the repair, depending on the size of the opening and the relative strength of the tissues. Many different types of operations have been used to repair incisional hernias. The reason there are many different techniques is that no single repair has proven to be superior in every case. In evaluating each of these procedures, one thing has become clear: simply suturing the muscle layers back together results in a high probability of the hernia coming back. The tissues that failed to hold together once will very likely fail again unless reinforced with an artificial material. This material can be placed using either an open technique, or in many cases with a laparoscopic approach. Since hernias are extremely variable in size and location, each case must be evaluated individually. The best repair is one with the lowest risk of complication, as well as the least possibility of the hernia coming back.
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