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June 2012 Hernia Newsletter >>
The Hernia Spectrum: Types, Presentation, and Referral
Review the most common types of simple and complex hernias, how they present, and when to refer patients for surgical repair.
Types and Incidence
Of the many of types of hernias, inguinal hernias are by far the most common. They comprise 75 percent of all hernias, and are 7 times more likely to occur in men. Femoral hernias, which are quite rare and more often seen in women, may be hard to distinguish from inguinal hernias on physical examination.1
Congenital umbilical hernias occur in approximately 1 of 6 infants; the incidence greatly increases in African-American infants. In adults, acquired umbilical hernias are 3 times more likely to occur in women, especially those who are obese or pregnant.1, 2
Incisional and primary ventral hernias comprise 10 percent of hernias. According to one study, incisional hernias occur in up to 20 percent of patients who have undergone abdominal surgery.3, 4 This rate may continue to increase as the incidence of hernia risk factors, such as obesity and diabetes, continues to rise.
Presentation and Complexity
Many simple hernias are asymptomatic at first. They usually present as a bulge that enlarges with increased intra-abdominal pressure and/or standing. Patients may experience minor pain or discomfort, or none at all, upon physical examination. These types of hernias reduce spontaneously or with manual manipulation.
Incarcerated hernias — those that cannot be reduced — may present with pain and tenderness. Left untreated, these hernias may become strangulated.
Strangulated hernias almost always present with pain, tenderness, and occasionally, symptoms of bowel obstruction, such as nausea and vomiting. There also may be skin changes, such as erythema overlying the hernia. Strangulated hernias are a surgical emergency and require immediate intervention.
Complex hernias are defined as hernias that recur despite multiple repairs, are associated with infections, or have resulted in bowel perforations or fistulas.
Complex hernias are particularly challenging to treat, as patients often have adhesions or mesh from prior surgical intervention and weakened abdominal wall tissues. These tissues must be substantially reinforced. According to one study, 10 to 53 percent of incisional hernias recur after initial repair.5
When to Refer
All patients with a diagnosed hernia should be referred for surgical evaluation. Patients with simple, asymptomatic hernias may only require monitoring. Surgery is usually indicated if the hernia causes pain or is at risk for incarceration or strangulation.
Any diagnostic images obtained by the primary care physician should be sent to the surgeon prior to the evaluation appointment. Any operative reports from previous repairs should also be sent, as they can greatly aid in surgical decision-making.
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For More Information
Learn more about UW Health’s Complex Hernia Clinic here
1. Erickson KM, Golladay ES. Abdominal Hernias: Epidemiology. Medscape. http://emedicine.medscape.com/article/189563-overview#a0199. Accessed May 15, 2012.