HERNIA TERMS
and
VOCABULARY
From The NORTH PENN HERNIA INSTITUTE
- HERNIA
A HERNIA is a protrusion of an internal organ or part of an organ through a tear, hole or defect in the wall of a body cavity (ie the abdominal wall muscle). A hernia may be likened to a failure in the sidewall of a pneumatic tire {Photo}. The tire's inner tube behaves like the organ and the sidewall like the body cavity wall providing the restraint.
Hernias may be present at birth, or be acquired later in life after repetitive heavy strain or injury to this abdominal wall muscle. Hernias may occur commonly in such areas as the lower abdomen or groin areas (Inguinal Hernia), at the region around the navel (Umbilical Hernia), or even through a prior surgical incision (Incisional Hernia). Hernias can re-occur in an area of a previous hernia repair (Recurrent Hernia). But Hernias can and do occur anywhere on the abdominal wall, and are given other various names such Femoral, Epigastric, Spigelian or Sports Hernia. The basic problem remains the same, the muscle container of the abdominal wall no longer holds the contents safely and securely in place. As pressure inside the abdomen pushes the abdominal contents through this defect, a bulge is created, and pain, burning or aching are experienced. These symptoms gradually increase in intensity with time as the hernia gradually enlarges, stretching surrounding tissue and irritating local nerve pain fibers.
Surgery is recommended to alleviate symptoms and prevent the hernia from becoming caught (Incarcerated) in the muscle tear or defect and having its blood supply damaged (Strangulated).
.- HERNIORRAPHY is the term used to describe the surgical repair of a hernia. Many techniques have evolved for the surgical treatment of hernias. Traditional techniques vogue for many, many decades, utilize a basically simple, suture closure of the defect, without addressing or reinforcing the surrounding, thinned and weakened hernia-proned tissue layer tissue. These older methods of repair however are associated with permanent tension on both the involved and surrounding tissues. Since tension is a significant long-term inhibitor of healing, this method of hernia repair is associated with an unacceptably high incidence of suture line disruption and eventual hernia recurrence. More recently however, methods that utilize mesh in a truly Tension-Free fashion have become progressively more available. These repair techniques are numerous, and vary both in their surgical details as well as in their effectiveness. Those Tension Free mesh repairs that provide full posteriorly-placed mesh reinforcement of not only the clinical hernia defect but the entire, thinned and weakened surrounding hernia-prone area as well, such as we recommend, offer the highest degree of long-term effectiveness for a successful repair.
.- INDIRECT INGUINAL HERNIA (Congenital)
These hernias occur as the result of a congenital opening and tissue "sac" present since birth. Although this sac may remain closed and without symptoms through early life, it may eventually open with enlargement of the muscle defect, allowing intra-abdominal contents to form a "bulge" developing through the internal inguinal ring and into the inguinal canal. The bulge is most often associated with pain. These hernias gradually enlarge, causing progressive symptoms.
.- DIRECT HERNIA (Acquired)
These hernias develop as a progressive weakness in an area called the Inguinal Floor (or in the medial triangle of the Myopectineal Orifice). With increase intra-abdominal pressure during activity, lifting, sports or injury, a weakness may develop in the fascial covering of the abdominal wall in this region. This weakness gradually, or at times rapidly, breaks through causing a true Hernia. The bulge gradually enlarges and causes pain as intra-abdominal contents push through the defect.
.- INCARCERATION
The trapping of abdominal contents within the Hernia itself. The bulge cannot be reduced or pushed back. This could mean that intestine from within the abdomen is trapped in the hernia and the risk of injury to abdominal contents and intestine is increased. Surgical release and hernia repair are emergently necessary to avoid injury to the intestine.
.- MESH Surgical material, made from synthetic plastic(ie: Polypropylene) or gortex) or even biodegradable substances, used to repair hernias. These sterile mesh "SCREENS", or "PATCHES" are soft, pliable, flexible, and 'wafer-thin' so as to conform to body movement and size. Yet they are remarkably strong to immediately add strength and fully repair the hernia while allowing rapid resumption of "Normal" activities, including SPORTS. Many varieties, shapes and sizes of Mesh Systems are available. Hernias differ from patient to patient, and we firmly believe that any given single mesh system or manufacturer is not appropriate for effective repair of all hernias. We therefore evaluate the anatomic and physical properties of each hernia at the time of surgery, then use our expertise to select the appropriate mesh form and TENSION FREE TECHNIQUE to satisfactorily repair your hernia defect appropriately.
.- RECURRENT HERNIA A Hernia that has been previously repaired surgically, and now has returned. Often multiply recurrent.
.- STRANGULATION Injury to the blood circulation to the intestine caused by Incarceration. The Intestine will become gangrenous or die if not corrected early. This is an absolute emergency situation requiring immediate surgery. Mortality rates are high in patients not treated quickly with surgery
.- HYDROCELE
A HYDROCELE is simply a collection of fluid, contained within a membrane sac surrounding the testicle. This membrane sac is generally a congenital remnant of the pathway that the testicle passed from within the abdomen where it is initially formed, down into the scrotum during fetal development. Usually, this tract or pathway closes after birth, but may persist in some patients. It is at times connected to a hernia sac (Communicating Hydrocele), while at other times is separated or not at all associated with a hernia (Non-Communicating Hydrocele). In children, the presence of a Hydrocele most frequently is associated with a hernia on the same side. Fluid may develop within this membrane sac spontaneously, or, in the case of a Communicating Hydrocele, drain into the sac along the hernia from inside the abdominal cavity. The size of the Hydrocele may fluctuate, often significantly in Communicating Hydroceles as fluid travels back and forth from within the abdomen to the Hydrocele sac. Hydroceles are successfully managed surgically and should be repaired when associated with a hernia, or when large and symptomatic or growing.
.- PERITONEUM
The PERITONEUM is the thin, membranous outer lining of the abdominal cavity, it fully surrounds the intestines and abdominal organs. It lies between the muscles of the abdominal wall, and the intestines. In our Tension Free techniques, mesh is placed between the under surface of the muscles, and the peritoneum layer, and not inside the abdomen itself. Therefor, mesh is not in contact directly with intestine and there is no concern about adhesions or intestinal injury. The peritoneum, although thin, is fully protective. The mesh however is under the muscle layer where it is much more effective in hernia repair than if it was placed on top of the muscle.
.- HEALING RIDGE
The HEALING RIDGE, which is a normal occurring event, is a term we use to describe the area of swelling and hardness beneath the incision after hernia repair surgery. This area of temporary swelling normally occurs and is progressive in extent for about 2-3 days after surgery. It may harden somewhat, feeling like a roll of quarters or even a small 'cucumber' beneath the skin in the region. It remains virtually unchanged for 2-3 weeks after which it gradually softens and flattens (taking an additional 2-3 weeks to complete on average). The size and duration of the 'ridge' is related to the size and complexity of the hernia itself. The ridge is caused by local tissue swelling and inflammation around the implanted mesh as it 'heals' into the surrounding muscle. It is not, per se, a complication, but is part of the normal process. We allow our patients to resume normal activity rapidly despite the presence of the healing ridge feeling that such activity maintains flexibility of the region and inhibits overly dense scar tissue formation.
.- TENSION FREE Technique utilized at the
NORTH PENN HERNIA INSTITUTE
whereby Hernias are repaired without pulling muscle together under tension. Using our "Tension Free" method, a sterile specifically designed surgical mesh, exactly positioned through a small incision, is utilized to safely and effectively repair the hernia defect.
This results in:
- Decreased post operative pain
- A significantly more rapid recovery
- Fewer restrictions on activity
- A less complicated recovery
- HERNIORRAPHY is the term used to describe the surgical repair of a hernia. Many techniques have evolved for the surgical treatment of hernias. Traditional techniques vogue for many, many decades, utilize a basically simple, suture closure of the defect, without addressing or reinforcing the surrounding, thinned and weakened hernia-proned tissue layer tissue. These older methods of repair however are associated with permanent tension on both the involved and surrounding tissues. Since tension is a significant long-term inhibitor of healing, this method of hernia repair is associated with an unacceptably high incidence of suture line disruption and eventual hernia recurrence. More recently however, methods that utilize mesh in a truly Tension-Free fashion have become progressively more available. These repair techniques are numerous, and vary both in their surgical details as well as in their effectiveness. Those Tension Free mesh repairs that provide full posteriorly-placed mesh reinforcement of not only the clinical hernia defect but the entire, thinned and weakened surrounding hernia-prone area as well, such as we recommend, offer the highest degree of long-term effectiveness for a successful repair.
- CANADIAN TECHNIQUE
A tissue-based suture only technique performed without using mesh. Muscle layers are individually dissected, and sewn together in several overlapping layers, often under significant tension. This technique, popularized in the 1970s and still utilized in many areas of the world but mostly still in Canada, is in fact equivalent to an original method described by Dr. Eduardo Bassini of the University of Padula in Italy in his 1887s manuscript (Radical Cure of Inguinal Hernias) whereby the three(3) anatomic layers of the posterior wall of the inguinal canal are sutured together in an over-lapping fashion. Using wire as the suture material of choice however, the Canadian surgeons at Shouldice re-copied this technique in more detail than had been previously done in North America, and did not invent a 'new' operation. This Canadian operation creates, in our opinion, unwanted and undue tension on the hernia repair, and is not per se a Tension-Free repair. We feel this results in added tissue swelling and pain. Such tension on the repair may inhibit and thereby prolong healing. Recovery may therefore be prolonged (even up to 6-8 weeks), and many surgeons do impose rigid post-operative restrictions after this method. Because of the tension this method may produce, healing can be incomplete. Therefore hernia recurrence rates are often quite high.
.- INCISIONAL HERNIA
Ventral or Incisional Hernias occur in the area of a prior abdominal incision. They develop as the result of a thinning, separation or tear in the muscle or tendon closure from prior surgery, often due to too much tension placed on the closure itself. These hernias may be small and asymptomatic at first, but eventually enlarge and become problematic causing possible Incarceration or Strangulation. Surgical repair is best performed early, when first diagnosed. Patients who are at or near ideal body weight are the ideal candidates for a Tension Free mesh repair.
(Ventral Hernia )
.- HERNIATED DISCS
A Herniated Disc refers to a problem of the spine where the tendinous padding between vertebrae protrudes into the nerves exiting the spinal cord. This is a Neurosurgical or Orthopedic problem and not a hernia of the abdominal wall. We are not experts in this particular area and cannot accurately comment on its diagnosis or treatment. Patients should be cared for by their personal physicians, or referred to Neurosurgeons or Orthopedic Surgeons with expertise
.- IDEAL BODY WEIGHT
For the best results and fastest recovery following Incisional Hernia repair, it is necessary for the patient to be at or near their Ideal Body Weight or IBW. This can be calculated as follows:- FOR WOMEN
- A.--100 pounds for the first 5 feet in height
- B.----5 pounds for each inch over 5 feet
- IBW equals A plus B above
- A.--100 pounds for the first 5 feet in height
- FOR MEN
- A.--105 pounds for the first 5 feet in height
- B.----6 pounds for each inch over 5 feet
- IBW equals A plus B above
- A.--105 pounds for the first 5 feet in height
It is necessary that patients be no more than 10% above IBW for safe and successful repair of Incisional Hernias, and mandatory to be considered a surgical candidate here at NPHI. These weight restrictions do not apply however to most Inguinal, Femoral or Umbilical Hernias, but are required pre-operatively for patients requiring Incisional Hernia repair performed at NPHI.
.- HIATAL HERNIAS
Hiatal Hernias occur within the abdomen, not on the abdominal wall. These are hernias through the diaphragm. As a result, acid refluxes from the stomach into the esophagus causing pain, heartburn, and ulceration of the esophagus. Treatment is mostly medical, but when surgery is necessary, the TENSION FREE method is not appropriate, and these hernias are repaired either through a Laparoscope, or with a formal surgical incision.
.- NEUROMA
NEUROMA- A neuroma is the thickening or localized swelling of a nerve that is usually the result of a compression or trauma. They are often described as benign nerve tumors, however in reality, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. In cases of neuroma formation after hernia surgery, the nerve gets pinched or damaged at the time of surgery (often inadvertently), and then swells, forming the neuroma. Burning pain, tingling, and numbness in the area is a common symptom. Sometimes this pain can become severe. Pain can be intermittent or constant, and is aggravated by anything that results in further pinching of the nerve in the area of the neuroma. Any surgical wound or laceration that injures a nerve can cause a neuroma. These are called traumatic Neuromas. Neuromas can result following surgery that may result in the cutting of a nerve if the end of the nerve is not subsequently propery handled (i.e., ligated with absorbable suture and burried into the fibers of adjacent muscle to protect it's end).
.- PAIN MANAGEMENT SPECIALISTS
These highly-trained physicians specialize in the treatment and management of chronic pain which may occur from a variety of causes. While true 'Board Certification', as recognized by the American Board of Medical Specialties is not yet available for these specialists, certification of training and expertise should be sought in evaluating their qualifications. Most of the qualified Pain Manaagement Specialists are, however Board Certified Anesthesiologists who also have advanced specific training in Pain Management. Treatments are recommended by these true specialists usually only after a thorough clinical evaluation, including an examination. Imaging studies such as an MRI or CT scan may or may not be required depending on each individual patient. Treatments, in addition to oral pain medication, may include injection therapy, either directly into the site of the pain, or regionally, as in the back (i.e., spinal or nerve root injections). Nerve ablation therapy such as can be achieved by Cryotherapy (cold current to freeze the nerve) or Radio-Frequency (RF) Nerve Ablation can be offered in some cases, especially those patients who respond to local injection therapy, albeit if only temporarally.
Pain Management Specialists can usualy be located within and through the Department of Anesthesia at most major Medical Centers.
.- MYOPECTINEAL ORIFICE The MYOPECTINEAL ORIFICE or MPO (For More Detail, Click HERE) is the Hernia-Prone, or Hernia-Vulnerable region of the groin where inguinal hernias or more properly 'groin hernias" are likely to develop. This inculdes the regions for the developement of Indirect, Direct as well as Femoral Hernias. Incomplete reinforcement of the MPO or tension placed on the tissues of the MPO is the most common cause for the development of recurrent hernias.
NEW PATIENT INFO 
- INCISIONAL HERNIA
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Many
Mesh Systems
are available to the Hernia Specialists at NORTH PENN HERNIA INSTITUTE. There are many techniques that are referred to as Tension Free Techniques. Since hernias differ from patient to patient, we strongly believe that any one single operation is not suited for all patients. We use our experience and knowledge to appropriately select which "Tension Free" method is best suited for each particular hernia. This assures that our patients receive the very best, most effective and safest hernia repair procedure available. It is this precise mesh system selection process and tailoring at surgery that forms the basis of what we call our Benchmark approach.
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