Abdominal Wall Diseases

Inguinal hernia is a swelling in the groin area that occurs when one or more organs or part of them (small intestine, epiploic cyst, sigmoid colon, bladder, etc.) in weak areas of the abdominal wall/among the weakened layers of abdominal muscles in the inguinal canal. The resulting swelling may be visible and painful, especially when the patient coughs, bends over or lifts heavy objects (when physically exerted).

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Clinical/ objective examination
– by inspection, palpation; while the patient is standing, the surgeon examines the groin area and asks the person to cough (coughing increases the pressure in the abdominal cavity and if the patient has a groin hernia, coughing will cause the hernia to swell outwards)

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Abdominal ultrasound – which is carried out when clinical examination suggests an associated intra-abdominal or urological pathology

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Soft tissue/scrotal ultrasound
– is performed to make differential diagosis with hydrocele (fluid accumulation around the testis), inguinal, testicular tumours

If the inguinal hernia is small, without symptoms, without bothering you, your surgeon may only recommend monitoring the hernia’s progress.

Larger inguinal hernias, or those that create discomfort, embarrassment or are painful, usually require surgery that can be performed either through an open approach (when appropriate) or, recommended, a laparoscopic approach. The procedure involves reduction/cutting of the hernia sac with the insertion of a mesh.
In the case of strangulated and incarcerated hernias, emergency surgery is required.

Ventral hernias are a pseudotumoral protrusion at the umbilicus or supraumbilical level, which may or may not be reducible, and which, on coughing, protrude further.

– Pain/discomfort in the umbilicus or supra-umbilicus, aggravated by physical exertion
– Umbilical/supraumbilical pseudotumour formation
– Skin changes, inflammatory processes in the umbilicus
– reducible (easily in and out)/irreducible (adhesions occur between the muscle defect and the hernia sac causing the hernia to become incarcerated) formation

– Clinical/objective examination- by inspection, palpation; surgeon examines the umbilical/epigastric area and asks the person to cough or to lift from the abdomen (coughing/physical exertion increases pressure in the abdominal cavity and if the patient has an umbilical/epigastric hernia, coughing will cause the hernia to swell outwards)
– Abdominal ultrasound – which is performed when an associated intra-abdominal pathology is suspected based on clinical examination
– Soft tissue ultrasound – which shows the defect in the abdominal wall/ whether the hernia is contained or not

If the ventral hernia is small, with no symptoms, without bothering you, your surgeon may only recommend monitoring the progress of the hernia.

Large ventral hernias, or those that create discomfort, embarrassment or are painful, usually require surgery that can be performed either through an open approach (when appropriate) or, recommended, through a laparoscopic approach, with or without the insertion (depending on the size of the defect of a prosthetic material/mesh).

In the case of strangulated and incarcerated hernias, emergency surgery is required.

If the patient with eventration does not show symptoms, does not bother him, the surgeon can only recommend monitoring, avoidance of strenuous physical exertion, wearing an inelastic abdominal support belt.

Large eviscerations, or those that create discomfort, embarrassment or are painful, usually require surgery that can be performed either through an open or laparoscopic approach, with or without the insertion (depending on the size of the defect) of a prosthetic material/mesh.

Incisional hernia or hernia is the weakening of the abdominal wall at the level of a former surgery, with the appearance of protrusions. Eventrations are favoured by immediate postoperative physical exertion, coughing, contipation, an improper suture, postoperative wound infection, weight gain or already present obesity.