Materiały źródłowe

• #1 The Biology of Hernia Formation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2276402/

  Abdominal wall hernias occur when tissue structure and function is lost at the load-bearing muscle, tendon and fascial layer. The fundamental biological mechanisms are primary fascial pathology or surgical wound failure. In both cases, cellular and extra-cellular molecular matrix defects occur. […] Abnormal collagen metabolism was an early biological mechanism proposed for the development of primary and incisional hernias. Immature collagen isoforms were measured in patients with inguinal and incisional hernias. Importantly, the collagen abnormality was detected in skin biopsies remote from the hernia site, supporting a genetic basis for hernia formation, although a large, population-based study of collagen expression in surgical patients needs to be done. […] Secondary fascial pathology occurs following acute laparotomy wound failure. This is in large part due to the replacement of fascial planes with scar tissue. It is well known that the incidence of recurrent incisional hernia increases with each attempt at repair. Fibroblast and wound collagen disorders were observed in scar from incisional hernia patients.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hernia-Pathophysiology.aspx

  A hernia refers to when an internal body part pushes through a weak area of muscle or the surrounding tissue wall. […] A weakness in the abdominal wall leads to a hole forming and abdominal organs or adipose tissue then push through the hole, creating a bulge. […] The pathophysiology of some of the most common types of hernias is described below. […] In cases of inguinal hernia, a loop of the intestine protrudes through a hole in the abdominal wall into the inguinal canal, which contains the spermatic cord. […] The weakness that occurs in the abdominal wall may be present at birth or may develop later on in life. […] An indirect inguinal hernia is one that occurs as a congenital lesion. […] Direct hernias are acquired rather than congenital and usually occur in people aged 25 or older.

• #3 Hernia Types, Causes, and Treatments | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/hernia-types-causes-and-treatments

  A hernia is a weakness or opening in the abdominal wall which often results in soft tissue such as fat or intestine protruding through the abdominal muscles and occupying the space under the skin. The mechanism of a hernia is like what happens with a bulge in a damaged tire, where the inner tube, normally contained by the hard rubber of the tire, extends through a thin or weakened place. The opening in the abdominal wall that leads to the hernia is also known as a hernia defect. […] Inguinal and ventral hernias may develop due to several factors, including obesity, aging, chronic cough such as with COPD, and strenuous physical activity requiring heavy lifting, such as construction work. […] Certain rare conditions such as collagen vascular disease or genetic defects involving connective tissue may also cause abdominal hernias.

• #4 The Biology of Hernia Formation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2276402/

  The majority of incisional hernias appear to develop following the mechanical disruption of laparotomy wounds occurring during the initial lag phase of the wound healing trajectory. […] In summary, incisional hernias occur when the laparotomy wound fails to heal. The fundamental mechanism may be an underlying wound healing defect, or, inadequate surgical technique. […] Most evidence supports that primary hernia formation derives from a biological deficiency of the extra-cellular matrix of most patients. It is a soft-tissue disease. […] Once surgically repaired, the fundamental mechanism for recurrent hernia disease includes inadequate surgical technique and how that interacts with the biological limits of wound healing. Incisional hernias may be considered chronic wounds expressing abnormal tissue repair pathways. […] The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculo-tendinous layer. This results in the inability to contain abdominal organs, support upright posture and maintain increased intra-peritoneal pressure during Valsalva.

• #5 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hernia-Pathophysiology.aspx

  A hernia refers to when an internal body part pushes through a weak area of muscle or the surrounding tissue wall. […] A weakness in the abdominal wall leads to a hole forming and abdominal organs or adipose tissue then push through the hole, creating a bulge. […] The pathophysiology of some of the most common types of hernias is described below. […] In cases of inguinal hernia, a loop of the intestine protrudes through a hole in the abdominal wall into the inguinal canal, which contains the spermatic cord. […] The weakness that occurs in the abdominal wall may be present at birth or may develop later on in life. […] An indirect inguinal hernia is one that occurs as a congenital lesion. […] Direct hernias are acquired rather than congenital and usually occur in people aged 25 or older.

• #6 Hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hernia_pathophysiology

  By far most hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or „defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. […] Most of the time, hernias develop when pressure in the compartment of the residing organ is increased, and the boundary is weak or weakened. […] Weakening of containing membranes or muscles is usually congenital (which explains part of the tendency of hernias to run in families), and increases with age (for example, degeneration of the annulus fibrosus of the intervertebral disc), but it may be on the basis of other illnesses, such as Ehlers-Danlos syndrome or Marfan syndrome, stretching of muscles during pregnancy, losing weight in obese people, etc., or because of scars from previous surgery.

• #7 Hernias – Surgical Treatment – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK6888/

  The pathogenesis of hernias is multifactorial. Congenital hernias are preformed hernial openings caused by incomplete closure of the abdominal wall (e.g., persistent processus vaginalis), while, in acquired hernias, the cause is increasing dehiscence of fascial structure with accompanying loss of abdominal wall strength. The develop typically in locations where larger blood vessels or the spermatic cord lie, or where previous incisions were made. […] Different etiological factors, such as increased intra-abdominal pressure (in pregnancy, intra-abdominal tumors, chronic obstructive lung disease, ascites, chronic intestinal obstruction, and adiposity), or pathological changes in connective tissue of the abdominal wall, are blamed, without conclusive significance. New material for understanding the pathogenetics has been provided by recent studies on collagen metabolism disorder, in which an increase of collagen III war proven in patients with hernia.

• #8 Pediatric Hernias: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/932680-overview

  The processus vaginalis is an outpouching of peritoneum attached to the testicle that trails behind as it descends retroperitoneally into the scrotum. When obliteration of the processus vaginalis fails to occur, inguinal hernia results. […] A review of embryonic development of the inguinal region is important to understanding the pathophysiology and surgical management of inguinal hernias. […] Before birth, the layers of the processus vaginalis normally fuse, closing off the entrance into the inguinal canal from the abdominal cavity. In some individuals, the processus vaginalis remains patent through infancy, into childhood, and possibly even into adulthood. The precise cause of the obliteration of the processus vaginalis is unknown, but some studies indicate that calcitonin gene-related peptide (CGRP), released from the genitofemoral nerve, may have a role in the fusion.

• #9 Inguinal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Inguinal_hernia

  In males, indirect hernias follow the same route as the descending testes, which migrate from the abdomen into the scrotum during the development of the urinary and reproductive organs. […] Although several mechanisms such as strength of the posterior wall of the inguinal canal and shutter mechanisms compensating for raised intra-abdominal pressure prevent hernia formation in normal individuals, the exact importance of each factor is still under debate. […] The physiological school of thought thinks that the risk of hernia is due to a physiological difference between patients who develop a hernia and those who do not, namely the presence of aponeurotic extensions from the transversus abdominis aponeurotic arch. […] Inguinal hernias mostly contain the omentum or a part of the small intestines, however, some unusual contents may be an appendicitis, diverticulitis, colon cancer, urinary bladder, ovaries, and rarely malignant lesions.

• #10 Hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hernia_pathophysiology

  By far most hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or „defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. […] Most of the time, hernias develop when pressure in the compartment of the residing organ is increased, and the boundary is weak or weakened. […] Weakening of containing membranes or muscles is usually congenital (which explains part of the tendency of hernias to run in families), and increases with age (for example, degeneration of the annulus fibrosus of the intervertebral disc), but it may be on the basis of other illnesses, such as Ehlers-Danlos syndrome or Marfan syndrome, stretching of muscles during pregnancy, losing weight in obese people, etc., or because of scars from previous surgery.

• #11 Hernia Types, Causes, and Treatments | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/hernia-types-causes-and-treatments

  A hernia is a weakness or opening in the abdominal wall which often results in soft tissue such as fat or intestine protruding through the abdominal muscles and occupying the space under the skin. The mechanism of a hernia is like what happens with a bulge in a damaged tire, where the inner tube, normally contained by the hard rubber of the tire, extends through a thin or weakened place. The opening in the abdominal wall that leads to the hernia is also known as a hernia defect. […] Inguinal and ventral hernias may develop due to several factors, including obesity, aging, chronic cough such as with COPD, and strenuous physical activity requiring heavy lifting, such as construction work. […] Certain rare conditions such as collagen vascular disease or genetic defects involving connective tissue may also cause abdominal hernias.

• #12 The Biology of Hernia Formation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2276402/

  Abdominal wall hernias occur when tissue structure and function is lost at the load-bearing muscle, tendon and fascial layer. The fundamental biological mechanisms are primary fascial pathology or surgical wound failure. In both cases, cellular and extra-cellular molecular matrix defects occur. […] Abnormal collagen metabolism was an early biological mechanism proposed for the development of primary and incisional hernias. Immature collagen isoforms were measured in patients with inguinal and incisional hernias. Importantly, the collagen abnormality was detected in skin biopsies remote from the hernia site, supporting a genetic basis for hernia formation, although a large, population-based study of collagen expression in surgical patients needs to be done. […] Secondary fascial pathology occurs following acute laparotomy wound failure. This is in large part due to the replacement of fascial planes with scar tissue. It is well known that the incidence of recurrent incisional hernia increases with each attempt at repair. Fibroblast and wound collagen disorders were observed in scar from incisional hernia patients.

• #13 Hernias – Surgical Treatment – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK6888/

  The pathogenesis of hernias is multifactorial. Congenital hernias are preformed hernial openings caused by incomplete closure of the abdominal wall (e.g., persistent processus vaginalis), while, in acquired hernias, the cause is increasing dehiscence of fascial structure with accompanying loss of abdominal wall strength. The develop typically in locations where larger blood vessels or the spermatic cord lie, or where previous incisions were made. […] Different etiological factors, such as increased intra-abdominal pressure (in pregnancy, intra-abdominal tumors, chronic obstructive lung disease, ascites, chronic intestinal obstruction, and adiposity), or pathological changes in connective tissue of the abdominal wall, are blamed, without conclusive significance. New material for understanding the pathogenetics has been provided by recent studies on collagen metabolism disorder, in which an increase of collagen III war proven in patients with hernia.

• #14 Pathological Tissue Changes and Hernia Formation | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4419-8574-3_18

  Classically, inguinal hernias are considered the result of a multifactorial process linking predisposing anatomical and dynamic factors: intra-abdominal pressure acting on a weak area, the myopectineal orifice, which is sealed by the transversalis fascia. All groin hernias are therefore characterized by the displacement of this fascia by a peritoneal sac. […] To these are added histobiochemical factors, which are unquestionably the least known at present, but very likely play a key role in the genesis of inguinal hernias. […] Hence, inguinal hernia could be considered a local manifestation of systemic collagen pathology. […] This is why we undertook a detailed study of the transversalis fascia and the sheath of the rectus abdominis muscle in control groups and in patients with inguinal hernias. We first analyzed the macroscopic biomechanical properties of these structures, then proceeded to the microscopic level in an attempt to clarify them by means of their histologic characteristics.

• #15 Pathological Tissue Changes and Hernia Formation | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4419-8574-3_18

  Classically, inguinal hernias are considered the result of a multifactorial process linking predisposing anatomical and dynamic factors: intra-abdominal pressure acting on a weak area, the myopectineal orifice, which is sealed by the transversalis fascia. All groin hernias are therefore characterized by the displacement of this fascia by a peritoneal sac. […] To these are added histobiochemical factors, which are unquestionably the least known at present, but very likely play a key role in the genesis of inguinal hernias. […] Hence, inguinal hernia could be considered a local manifestation of systemic collagen pathology. […] This is why we undertook a detailed study of the transversalis fascia and the sheath of the rectus abdominis muscle in control groups and in patients with inguinal hernias. We first analyzed the macroscopic biomechanical properties of these structures, then proceeded to the microscopic level in an attempt to clarify them by means of their histologic characteristics.

• #16 Pathophysiology

  http://surgstudent.org/lectures/her/node12.html

  The arching fibres of the internal oblique and transversus abdominus contract when the muscles of the abdomen contract. This acts as a shutter on the posterior wall to protect it from herniation. This is termed the Shutter Mechanism. […] In addition this contraction also narrows the deep ring. The narrowing of the deep ring is termed the Closure Mechanism. […] There are two important physiological mechanisms that protect against the formation of inguinal herniae with increased abdominal pressure. They are the Shutter and Closure mechanisms. […] Dysfunction of these two mechanisms may contribute to hernia formation. It has been noted that appendisectomy increases the risk of right sided inguinal hernia threefold. This may be due to dysfunction of the shutter mechanism due to damage of nerves in the abdominal wall at the time of appendisectomy.

• #17 Pathophysiology

  http://surgstudent.org/lectures/her/node12.html

  The arching fibres of the internal oblique and transversus abdominus contract when the muscles of the abdomen contract. This acts as a shutter on the posterior wall to protect it from herniation. This is termed the Shutter Mechanism. […] In addition this contraction also narrows the deep ring. The narrowing of the deep ring is termed the Closure Mechanism. […] There are two important physiological mechanisms that protect against the formation of inguinal herniae with increased abdominal pressure. They are the Shutter and Closure mechanisms. […] Dysfunction of these two mechanisms may contribute to hernia formation. It has been noted that appendisectomy increases the risk of right sided inguinal hernia threefold. This may be due to dysfunction of the shutter mechanism due to damage of nerves in the abdominal wall at the time of appendisectomy.

• #18 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  The pinchcock action of the internal ring musculature during abdominal muscular straining prohibits protrusion of the intestine into a patent processus. Muscle paralysis or injury can disable the shutter effect. In addition, the transversus abdominis aponeurosis flattens during tensing, thus reinforcing the inguinal floor. A congenitally high position of the aponeurotic arch may preclude the buttressing effect. Neurapraxic or neurolytic sequelae of appendectomy or femoral vascular procedures may increase the incidence of hernia in these patients. […] Clinical presentations suggest repetitive stress as a factor in hernia development. Increased intra-abdominal pressure is seen in a variety of disease states and seems to contribute to hernia formation in these populations. Elevated intra-abdominal pressure is associated with chronic cough, ascites, increased peritoneal fluid from biliary atresia, peritoneal dialysis or ventriculoperitoneal shunts, intraperitoneal masses or organomegaly, and obstipation.

• #19 Surgical physiology of inguinal hernia repair – a study of 200 cases | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-3-2

  Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. […] A physiologically dynamic and strong posterior inguinal wall, and the shielding and compression action of the muscles and aponeuroses around the inguinal canal are important factors that prevent hernia formation or hernia recurrence after repair. […] The role of the EOA in anterior-posterior compression of the inguinal canal to prevent herniation is restored by providing a strong and physiologically dynamic posterior wall. […] The posterior inguinal wall is composed of condensed transversalis fascia along with the aponeurotic extensions from the transversus abdominis aponeurotic arch. […] The strength of the posterior inguinal wall is directly related to the number of aponeurotic fibers it contains and there is great variation in normal anatomy.

• #20 Surgical physiology of inguinal hernia repair – a study of 200 cases | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-3-2

  The posterior inguinal wall should be described as an independent entity, playing an important role in the prevention of hernia formation, not only because of its mechanical strength but also because of its dynamic nature. […] The action of the muscular and aponeurotic structures around the inguinal canal plays an equally important role in preventing the hernia formation. […] Contraction of a muscle increases the tone of the muscle to guard against the 'blows’. […] This is possible only if the posterior wall is also strong and physiologically dynamic. […] The importance of the strength of this fascia in preventing herniation is not properly emphasized in literature. […] The author’s technique is physiologically sound because: A) Absent aponeurotic extensions in the posterior wall are replaced with an aponeurotic structure. B) Additional muscle strength of the external oblique muscle helps the weakened muscle arch to keep the newly formed posterior wall physiologically dynamic. C) Contractions of the muscle arch are improved.

• #21 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  The pinchcock action of the internal ring musculature during abdominal muscular straining prohibits protrusion of the intestine into a patent processus. Muscle paralysis or injury can disable the shutter effect. In addition, the transversus abdominis aponeurosis flattens during tensing, thus reinforcing the inguinal floor. A congenitally high position of the aponeurotic arch may preclude the buttressing effect. Neurapraxic or neurolytic sequelae of appendectomy or femoral vascular procedures may increase the incidence of hernia in these patients. […] Clinical presentations suggest repetitive stress as a factor in hernia development. Increased intra-abdominal pressure is seen in a variety of disease states and seems to contribute to hernia formation in these populations. Elevated intra-abdominal pressure is associated with chronic cough, ascites, increased peritoneal fluid from biliary atresia, peritoneal dialysis or ventriculoperitoneal shunts, intraperitoneal masses or organomegaly, and obstipation.

• #22 Inguinal Hernia: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia

  A hernia occurs when tissue from one body cavity bulges through an opening in your muscle wall into another. Inguinal hernias are the most common type of hernia. They happen when abdominal tissue, such as belly fat or a loop of intestines, bulges through an opening in your lower abdominal wall. This is the wall that separates your abdomen from your groin. Inguinal hernias occur in the inguinal canal, which is a passageway that runs down either side of your pelvis into your sex organs. […] An inguinal hernia occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through. Many things can contribute to this, including: An opening or weak spot that’s present at birth. Congenital differences in the strength of your connective tissue (collagen). An opening or weak spot from previous abdominal surgery. Chronic coughing or sneezing. Chronic straining to pee or poop. Frequent strenuous exercise or manual labor. Years of pregnancy and carrying small children. Jobs that require standing for many hours at a time. Intrabdominal pressure from chronic obesity. Normal age-related tissue degeneration.

• #23 Hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hernia_pathophysiology

  Many conditions chronically increase intra-abdominal pressure, (pregnancy, ascites, COPD, dyschezia, benign prostatic hypertrophy) and hence abdominal hernias are very frequent. Increased intracranial pressure can cause parts of the brain to herniate through narrowed portions of the cranial cavity or through the foramen magnum. Increased pressure on the intervertebral discs, as produced by heavy lifting or lifting with improper technique, increases the risk of herniation.

• #24 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  Inguinal hernias are commonly classified as either direct or indirect. A direct inguinal hernia usually occurs as a consequence of a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon. […] An indirect inguinal hernia follows the tract through the inguinal canal. It results from a persistent processus vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal ring, approximately midway between the pubic symphysis and the anterior superior iliac spine, and courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric arteries, subcutaneously and slightly above the pubic tubercle. The hernia contents then follow the tract of the testicle down into the scrotal sac.

• #25 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hernia-Pathophysiology.aspx

  A hernia refers to when an internal body part pushes through a weak area of muscle or the surrounding tissue wall. […] A weakness in the abdominal wall leads to a hole forming and abdominal organs or adipose tissue then push through the hole, creating a bulge. […] The pathophysiology of some of the most common types of hernias is described below. […] In cases of inguinal hernia, a loop of the intestine protrudes through a hole in the abdominal wall into the inguinal canal, which contains the spermatic cord. […] The weakness that occurs in the abdominal wall may be present at birth or may develop later on in life. […] An indirect inguinal hernia is one that occurs as a congenital lesion. […] Direct hernias are acquired rather than congenital and usually occur in people aged 25 or older.

• #26 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  Inguinal hernias are commonly classified as either direct or indirect. A direct inguinal hernia usually occurs as a consequence of a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon. […] An indirect inguinal hernia follows the tract through the inguinal canal. It results from a persistent processus vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal ring, approximately midway between the pubic symphysis and the anterior superior iliac spine, and courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric arteries, subcutaneously and slightly above the pubic tubercle. The hernia contents then follow the tract of the testicle down into the scrotal sac.

• #27 The pathophysiology of rectus abdominis diastasis and hernias

  https://www.darecchiosurgery.com/en/anatomy-lore/pathophysiology

  Indirect inguinal hernia, also called external oblique, originates through a congenital or acquired failure of the internal inguinal ring and inguinal canal. […] Direct inguinal hernia is an acquired hernia and originates from a weakening of the posterior wall of the inguinal canal. […] The crural or femoral hernia makes its way through a pathway called the femoral canal. […] Umbilical hernia results from a poor closure, weakening, or loss of substance of the structures that make up the umbilicus. […] Most umbilical hernias in adults are acquired in nature and related to increased volume/pressure in the abdominal cavity, situations that typically occur in pregnancy, obesity, or excessive physical strain. […] Frequently, post-pregnancy umbilical hernia is associated with the presence of rectus abdominis diastasis, so an accurate diagnosis is necessary before planning a simple hernial repair that might otherwise result in an incomplete and fragile reconstruction. […] Spigelium hernia is formed by protrusion of pre-peritoneal fat and parietal peritoneum through subsidence of the Spigelium region. […] Laparocele is a complication at the site of a previous abdominal surgical incision.

• #28 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  Inguinal hernias are commonly classified as either direct or indirect. A direct inguinal hernia usually occurs as a consequence of a defect or weakness in the transversalis fascia area of the Hesselbach triangle. The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoined tendon. […] An indirect inguinal hernia follows the tract through the inguinal canal. It results from a persistent processus vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal ring, approximately midway between the pubic symphysis and the anterior superior iliac spine, and courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric arteries, subcutaneously and slightly above the pubic tubercle. The hernia contents then follow the tract of the testicle down into the scrotal sac.

• #29 The pathophysiology of rectus abdominis diastasis and hernias

  https://www.darecchiosurgery.com/en/anatomy-lore/pathophysiology

  Indirect inguinal hernia, also called external oblique, originates through a congenital or acquired failure of the internal inguinal ring and inguinal canal. […] Direct inguinal hernia is an acquired hernia and originates from a weakening of the posterior wall of the inguinal canal. […] The crural or femoral hernia makes its way through a pathway called the femoral canal. […] Umbilical hernia results from a poor closure, weakening, or loss of substance of the structures that make up the umbilicus. […] Most umbilical hernias in adults are acquired in nature and related to increased volume/pressure in the abdominal cavity, situations that typically occur in pregnancy, obesity, or excessive physical strain. […] Frequently, post-pregnancy umbilical hernia is associated with the presence of rectus abdominis diastasis, so an accurate diagnosis is necessary before planning a simple hernial repair that might otherwise result in an incomplete and fragile reconstruction. […] Spigelium hernia is formed by protrusion of pre-peritoneal fat and parietal peritoneum through subsidence of the Spigelium region. […] Laparocele is a complication at the site of a previous abdominal surgical incision.

• #30 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  A femoral hernia follows the tract below the inguinal ligament through the femoral canal. The canal lies medial to the femoral vein and lateral to the lacunar (Gimbernat) ligament. Because femoral hernias protrude through such a small defined space, they frequently become incarcerated or strangulated. […] An umbilical hernia occurs through the umbilical fibromuscular ring, which is usually obliterated by age 2 years. […] Although umbilical hernias in children arise from failed closure of the umbilical ring, only one in 10 adults with umbilical hernias had this defect as a child. Adult umbilical hernias occur through a canal bordered anteriorly by the linea alba, posteriorly by the umbilical fascia, and laterally by the rectus sheath. […] A Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect. This hernia involves only a portion of the circumference of the bowel. Thus, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting.

• #31 Femoral Hernia – Risk Factors – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/femoral-hernia/

  Femoral hernias are a relatively uncommon hernia but are an important problem due to their high rate of strangulation from their narrow neck. […] Femoral hernias occur when abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal. […] The rigidity of the borders of the femoral ring, especially the concave margin of the lacunar ligament and the bony pelvis posteriorly, results in femoral hernias being prone to obstruction and strangulation requiring urgent surgical intervention. […] The main risk factors for developing a femoral hernia include female gender, pregnancy (higher incidence in multiparous women), raised intra-abdominal pressure (e.g. heavy lifting, chronic constipation), and increasing age. […] Femoral hernias will commonly present as a small lump in the groin.

• #32 Femoral Hernia – Risk Factors – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/femoral-hernia/

  Femoral hernias are a relatively uncommon hernia but are an important problem due to their high rate of strangulation from their narrow neck. […] Femoral hernias occur when abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal. […] The rigidity of the borders of the femoral ring, especially the concave margin of the lacunar ligament and the bony pelvis posteriorly, results in femoral hernias being prone to obstruction and strangulation requiring urgent surgical intervention. […] The main risk factors for developing a femoral hernia include female gender, pregnancy (higher incidence in multiparous women), raised intra-abdominal pressure (e.g. heavy lifting, chronic constipation), and increasing age. […] Femoral hernias will commonly present as a small lump in the groin.

• #33 Femoral Hernia – Risk Factors – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/femoral-hernia/

  Femoral hernias are a relatively uncommon hernia but are an important problem due to their high rate of strangulation from their narrow neck. […] Femoral hernias occur when abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal. […] The rigidity of the borders of the femoral ring, especially the concave margin of the lacunar ligament and the bony pelvis posteriorly, results in femoral hernias being prone to obstruction and strangulation requiring urgent surgical intervention. […] The main risk factors for developing a femoral hernia include female gender, pregnancy (higher incidence in multiparous women), raised intra-abdominal pressure (e.g. heavy lifting, chronic constipation), and increasing age. […] Femoral hernias will commonly present as a small lump in the groin.

• #34 Hiatal Hernia – Wake Gastroenterology

  https://wakegastro.com/patient-info/patient-education/hiatal-hernia/

  A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. […] In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. […] Other potentially contributing factors include: 1) a permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up; and 2) an abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards. […] When a hiatal hernia is present, two changes occur. First, the sphincter slides up into the chest while the diaphragm remains stationery. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap, and as a result, the total pressure at the gastro-esophageal junction decreases. Second, when the gastro-esophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve-like effect is lost. Both changes promote reflux of acid. […] Hiatal hernias contribute to gastroesophageal reflux disease. […] The treatment of most hiatal hernias is the same as for the associated GERD.

• #35 Hiatus Hernia – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

  Etiology of hiatus hernia is usually unknown, but a hiatus hernia is thought to be acquired through stretching of the fascial attachments between the esophagus and diaphragm at the hiatus (the opening through which the esophagus traverses the diaphragm). […] There are 2 main types of hiatus hernia: […] A sliding hiatus hernia is a common incidental finding on radiograph; therefore, the relationship of hernia to symptoms is unclear. […] Although most patients with gastroesophageal reflux disease (GERD) have some degree of hiatus hernia, 50% of patients with hiatus hernia have GERD. […] A paraesophageal hiatus hernia is generally asymptomatic but, unlike a sliding hiatus hernia, may incarcerate and strangulate. […] For a paraesophageal hernia, repair should be considered because of the risk of strangulation.

• #36 Hiatal Hernia – Wake Gastroenterology

  https://wakegastro.com/patient-info/patient-education/hiatal-hernia/

  A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. […] In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. […] Other potentially contributing factors include: 1) a permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up; and 2) an abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards. […] When a hiatal hernia is present, two changes occur. First, the sphincter slides up into the chest while the diaphragm remains stationery. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap, and as a result, the total pressure at the gastro-esophageal junction decreases. Second, when the gastro-esophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve-like effect is lost. Both changes promote reflux of acid. […] Hiatal hernias contribute to gastroesophageal reflux disease. […] The treatment of most hiatal hernias is the same as for the associated GERD.

• #37 Hiatus Hernia – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

  Etiology of hiatus hernia is usually unknown, but a hiatus hernia is thought to be acquired through stretching of the fascial attachments between the esophagus and diaphragm at the hiatus (the opening through which the esophagus traverses the diaphragm). […] There are 2 main types of hiatus hernia: […] A sliding hiatus hernia is a common incidental finding on radiograph; therefore, the relationship of hernia to symptoms is unclear. […] Although most patients with gastroesophageal reflux disease (GERD) have some degree of hiatus hernia, 50% of patients with hiatus hernia have GERD. […] A paraesophageal hiatus hernia is generally asymptomatic but, unlike a sliding hiatus hernia, may incarcerate and strangulate. […] For a paraesophageal hernia, repair should be considered because of the risk of strangulation.

• #38 Hiatal hernia – epidemiology, pathogenesis, diagnostic • Postępy Nauk Medycznych 5/2018 • Czytelnia Medyczna BORGIS

  https://www.czytelniamedyczna.pl/6473,hiatal-hernia-epidemiology-pathogenesis-diagnostic.html

  Hiatal hernia may be congenital or acquired. Among acquired hiatal hernias, traumatic and nontraumatic are distinguished. The most common types of hernia are acquired in non-traumatic manner. Nontraumatic acquired hernias are divided into four subtypes: sliding (type I) and paraoesophageal (type II). Mixed type with coexisting features of sliding and paraoesophageal hernia are also observed (type III). IV type of hiatal hernia is connected with short esophagus. Sliding hiatal hernia is most common type of hiatal hernia. It occurs when the gastro-esophageal junction, along with the part of the stomach, migrates to the mediastinum through the esophagus. In the majority of patients with esophageal hernia, no symptoms are observed, in part of patients symptoms of reflux are visible. This type of hernia interferes with the anti-reflux barrier mechanisms in several ways. The lower esophageal sphincter (LES) relocates from an area with positive pressure inside the abdominal cavity to the area of low pressure in the thorax, which interferes with the activity of the sphincter. What is more, the relaxation of diaphragm crura reduces the anti-reflux barrier of the esophagus. The Hiss angle is lost in the diaphragmatic hernia, which causes higher risk of regurgitation of gastric contents. These changes, not only predispose to reflux of gastric contents to the esophagus, but also prolong the time of acid contact with the esophageal epithelium.

• #39 Hiatus hernia : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo48.html

  Hiatal hernia generally denotes upward displacement of the stomach through the diaphragmatic esophageal hiatus into the thoracic cavity. […] Sliding hiatal hernias contribute to gastroesophageal reflux through several different mechanisms and they also impair esophageal emptying. […] The main clinical implication of type I hiatal hernias is of the propensity to develop reflux disease, the likelihood of which increases with increasing hernia size. […] A key function of the EGJ is to minimize gastroesophageal reflux. This is accomplished by a complex valvular mechanism, the function of which is partly attributable to the esophagus, partly to the stomach, and partly to the crural diaphragm. […] Mechanistic studies of reflux disease have revealed three dominant patterns of EGJ incompetence: (1) transient LES relaxations, (2) hypotensive LES, and (3) anatomic disruption of the EGJ associated with a hiatal hernia.

• #40 Hiatal Hernia – Wake Gastroenterology

  https://wakegastro.com/patient-info/patient-education/hiatal-hernia/

  A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. […] In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. […] Other potentially contributing factors include: 1) a permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up; and 2) an abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards. […] When a hiatal hernia is present, two changes occur. First, the sphincter slides up into the chest while the diaphragm remains stationery. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap, and as a result, the total pressure at the gastro-esophageal junction decreases. Second, when the gastro-esophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve-like effect is lost. Both changes promote reflux of acid. […] Hiatal hernias contribute to gastroesophageal reflux disease. […] The treatment of most hiatal hernias is the same as for the associated GERD.

• #41 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  An incisional hernia is an iatrogenic condition that occurs in 2-10% of all abdominal operations secondary to breakdown of the fascial closure of a surgical procedure. […] A spigelian hernia occurs through a defect in the spigelian fascia, defined by the lateral edge of the rectus abdominis at the semilunar line. Abnormal orientation of the semilunar and semicircular lines, along with obesity, increased intra-abdominal pressure, aging, and rapid weight loss, leads to the production of spigelian hernias. […] An obturator hernia passes through the obturator foramen, following the path of the obturator nerves and muscles. There is a strong female preponderance (female-to-male ratio, 6:1), because of a gender-specific larger canal diameter; this hernia is also much more likely to occur in the elderly.

• #42 The Biology of Hernia Formation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2276402/

  Abdominal wall hernias occur when tissue structure and function is lost at the load-bearing muscle, tendon and fascial layer. The fundamental biological mechanisms are primary fascial pathology or surgical wound failure. In both cases, cellular and extra-cellular molecular matrix defects occur. […] Abnormal collagen metabolism was an early biological mechanism proposed for the development of primary and incisional hernias. Immature collagen isoforms were measured in patients with inguinal and incisional hernias. Importantly, the collagen abnormality was detected in skin biopsies remote from the hernia site, supporting a genetic basis for hernia formation, although a large, population-based study of collagen expression in surgical patients needs to be done. […] Secondary fascial pathology occurs following acute laparotomy wound failure. This is in large part due to the replacement of fascial planes with scar tissue. It is well known that the incidence of recurrent incisional hernia increases with each attempt at repair. Fibroblast and wound collagen disorders were observed in scar from incisional hernia patients.

• #43 The Biology of Hernia Formation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2276402/

  Laparotomy wound failure and the loss of normal wound healing architecture may induce the selection of an abnormal population of wound repair fibroblasts, as occurs in chronic wounds. This could result in the expression of abnormal structural collagen and also explain the high incidence of recurrent incisional hernias. […] One mechanism for phenotypic selection of abnormal laparotomy wound repair fibroblasts is the loss of abdominal wall load force signaling as the incision mechanically fails. […] It is likely that early mechanical failure of the laparotomy wound induces pathological function of wound repair fibroblasts. […] It is possible that a subset of incisional hernia patients expresses a defect in extra-cellular matrix and or wound repair function. […] It is hard to resolve that mechanism with the fact that the majority of surgical patients have no history of a wound healing defect (making them surgical candidates) and also do not express a defect at the primary surgical site.

• #44 Biomechanical stability of hernia-damaged abdominal walls | Scientific Reports

  https://www.nature.com/articles/s41598-023-31674-w

  Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. […] Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. […] Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2-8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm.

• #45 Biomechanical stability of hernia-damaged abdominal walls | Scientific Reports

  https://www.nature.com/articles/s41598-023-31674-w

  Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. […] Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. […] Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2-8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm.

• #46 Biomechanical stability of hernia-damaged abdominal walls | Scientific Reports

  https://www.nature.com/articles/s41598-023-31674-w

  The current numerical study sheds light on the optimum position through the abdominal tissues. […] The figures also show that the external stress decreases by about 50% when onlay mesh is implanted. Applying the mesh implant at the retrorectus plane reduces the stress by about 50% on average. […] The most critical region is rectus abdominis, where cracks (or hernia damage zones) of critical size 4.1 cm or larger can propagate (i.e. grow). In the internal oblique, slightly larger cracks of sizes 5.2 cm can propagate. As for the external oblique and transversus abdominis, cracks of sizes 8 cm and 8.2 cm, respectively can propagate. […] The proposed workflow combined biomechanics and clinical knowledge to predict the response of a typical digitally reconstructed abdominal wall to internal pressure using non-linear geometrical changes, non-linear interactions and non-linear material behaviour.

• #47 Inguinal Hernia: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia

  A hernia occurs when tissue from one body cavity bulges through an opening in your muscle wall into another. Inguinal hernias are the most common type of hernia. They happen when abdominal tissue, such as belly fat or a loop of intestines, bulges through an opening in your lower abdominal wall. This is the wall that separates your abdomen from your groin. Inguinal hernias occur in the inguinal canal, which is a passageway that runs down either side of your pelvis into your sex organs. […] An inguinal hernia occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through. Many things can contribute to this, including: An opening or weak spot that’s present at birth. Congenital differences in the strength of your connective tissue (collagen). An opening or weak spot from previous abdominal surgery. Chronic coughing or sneezing. Chronic straining to pee or poop. Frequent strenuous exercise or manual labor. Years of pregnancy and carrying small children. Jobs that require standing for many hours at a time. Intrabdominal pressure from chronic obesity. Normal age-related tissue degeneration.

• #48 Hernia Types, Causes, and Treatments | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/hernia-types-causes-and-treatments

  A hernia is a weakness or opening in the abdominal wall which often results in soft tissue such as fat or intestine protruding through the abdominal muscles and occupying the space under the skin. The mechanism of a hernia is like what happens with a bulge in a damaged tire, where the inner tube, normally contained by the hard rubber of the tire, extends through a thin or weakened place. The opening in the abdominal wall that leads to the hernia is also known as a hernia defect. […] Inguinal and ventral hernias may develop due to several factors, including obesity, aging, chronic cough such as with COPD, and strenuous physical activity requiring heavy lifting, such as construction work. […] Certain rare conditions such as collagen vascular disease or genetic defects involving connective tissue may also cause abdominal hernias.

• #49 Hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hernia_pathophysiology

  By far most hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or „defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. […] Most of the time, hernias develop when pressure in the compartment of the residing organ is increased, and the boundary is weak or weakened. […] Weakening of containing membranes or muscles is usually congenital (which explains part of the tendency of hernias to run in families), and increases with age (for example, degeneration of the annulus fibrosus of the intervertebral disc), but it may be on the basis of other illnesses, such as Ehlers-Danlos syndrome or Marfan syndrome, stretching of muscles during pregnancy, losing weight in obese people, etc., or because of scars from previous surgery.

• #50 What Is a Hernia? Inguinal, Incisional, Umbilical, Hiatal, and Femoral Hernias

  https://www.webmd.com/digestive-disorders/understanding-hernia-basics

  You get a hernia when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. […] Ultimately, hernias are caused by a combination of pressure and an opening or weakness in the muscle or fascia. The pressure pushes an organ or tissue through the weak spot. […] Some people are born with a hernia. This is called a congenital hernia. Its more common in people who: […] Hernias usually dont get better on their own. They tend to get bigger. In rare cases, they can lead to life-threatening complications. […] Hernias usually dont start out as serious, but they get worse over time. Eventually, most people need surgery. If left untreated, a hernia might get stuck in the hole of the muscle wall. This could cause pain and prevent blood from reaching the affected tissue, leading to cell death.

• #51 What Is a Hernia? Inguinal, Incisional, Umbilical, Hiatal, and Femoral Hernias

  https://www.webmd.com/digestive-disorders/understanding-hernia-basics

  Sometimes, a hernia can get stuck in the hole in the wall of muscle or connective tissue. This is called incarceration. In severe cases, this can cut off blood flow, leading to cell death. If your bowels get stuck in the hernia, it could also prevent food and gas from passing through the digestive system.

• #52 Inguinal hernia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547

  An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. […] Inguinal hernias occur when part of the membrane lining the abdominal cavity (omentum) or intestine protrudes through a weak spot in the abdomen often along the inguinal canal, which carries the spermatic cord in men. […] In many people, the abdominal wall weakness that leads to an inguinal hernia occurs prior to birth when a weakness in the abdominal wall muscle doesn’t close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking. […] In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone. […] An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.

• #53 Femoral Hernia – Risk Factors – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/femoral-hernia/

  The tightness of the femoral ring means that the hernia is unlikely to be reducible. […] The complications that can occur with any hernia are: Irreducible / incarcerated the contents of the hernia are unable to return to their original cavity, Obstruction the bowel lumen has become obstructed, leading to the clinical features of bowel obstruction, Strangulation compression of the hernia has compromised the blood supply, leading to the bowel becoming ischaemic. […] A strangulated hernia is a surgical emergency and requires an urgent operation. […] All femoral hernias should be managed surgically. […] The risk of strangulation of femoral hernias increases with time following initial diagnosis; after 3 months the risk of strangulation is 22% and reaches 45% after 21 months. […] Femoral hernias have a high rate of strangulation, urgent surgery is therefore mandatory.

• #54 Abdominal Hernias: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/189563-overview

  A femoral hernia follows the tract below the inguinal ligament through the femoral canal. The canal lies medial to the femoral vein and lateral to the lacunar (Gimbernat) ligament. Because femoral hernias protrude through such a small defined space, they frequently become incarcerated or strangulated. […] An umbilical hernia occurs through the umbilical fibromuscular ring, which is usually obliterated by age 2 years. […] Although umbilical hernias in children arise from failed closure of the umbilical ring, only one in 10 adults with umbilical hernias had this defect as a child. Adult umbilical hernias occur through a canal bordered anteriorly by the linea alba, posteriorly by the umbilical fascia, and laterally by the rectus sheath. […] A Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect. This hernia involves only a portion of the circumference of the bowel. Thus, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting.

• #55

  https://www.concilio.com/en/general-surgery-hernia-pathology

  In general, a hernia is characterized by the passage of an organ through a natural orifice. Several factors encourage the appearance of a hernia, including carrying heavy objects, constipation, benign prostatic hyperplasia, and even pregnancy. Even if hernias are considered benign, this condition can generate complications at any moment, like intestinal strangling or intestinal occlusion. […] The intervention involves reducing or reintegrating the mass and closing the orifice with the help of a prothesis.

• #56 Abdominal hernia | PPT

  https://www.slideshare.net/slideshow/abdominal-hernia-232714041/232714041

  A hernia is the bulging of part of the contents of the abdominal cavity through a weakness in the abdominal wall. […] Pathophysiology of hernia formation Herniation has been attributed to high pressures from constipation, prostatic symptoms, excessive coughing in respiratory disease and obesity Hernia is a collagen disease Hormonally induced laxity of pelvic ligaments in pregnancy. In elderly people due to degenerative weakness of muscles and fibrous tissue. Hernia is more common in smokers. […] Common principles in abdominal hernia hernia has two essential components Defect in the wall and Content Content of the hernia may be tissue from the extraperitoneal, urinary bladder, intraperitoneal structures such as bowel or omentum. […] The term mesh refers to prosthetic material, either a net or a flat sheet, which is used to strengthen a hernia repair.

• #57 Abdominal hernia | PPT

  https://www.slideshare.net/slideshow/abdominal-hernia-232714041/232714041

  Most meshes used today are synthetic polymers of Polypropylene :- strong monofilament mesh, no antibacterial properties, hydrophobic nature, and monofilament microstructure impede bacterial in-growth Polyester:- braided filament mesh, allow infection to take hold, aided by its hydrophilic property. […] Synthetic absorbable meshes, such as those made from polyglycolic acid fibre. No current role in hernia repair because they absorb and induce minimal collagen deposition. […] The presence of infection limits the use of mesh, particularly heavyweight types. […] Herniation has been attributed to high pressures from constipation, prostatic symptoms, excessive coughing in respiratory disease and obesity. […] Hernia is a collagen disease.

• #58 Surgical Alloplastic Approach with Dual Mesh in a Multisacular, Recurrent Incisional Hernia – Case Presentation – Medicina Moderna

  https://medicinamoderna.ro/surgical-alloplastic-approach-with-dual-mesh-in-a-multisacular-recurrent-incisional-hernia-case-presentation/

  Repairing an incisional ventral hernia represents a challenge for the surgeon. […] To perform the wall repair it is of utmost importance to understand the pathogenesis of the hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. […] The goals of incisional hernia repair are the prevention of visceral eventration, incorporation of the abdominal wall in the repair, provision of dynamic muscular support, and restoration of abdominal wall continuity in a tension-free manner.

• #59 Sports Hernia (Athletic Pubalgia) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

  A sports hernia will usually cause severe pain in the groin area at the time of the injury. The pain typically gets better with rest but comes back when you return to sports activity, especially with twisting movements. […] A common sign of sports hernia is pain during a resisted sit-up. […] In many cases, 4 to 6 weeks of physical therapy will resolve any pain and allow an athlete to return to sports. If, however, the pain comes back when you resume sports activities, you may need to consider surgery to repair the torn tissues. […] Surgery to repair the torn tissues in the groin can be done as a traditional, open procedure with one long incision or an endoscopic procedure. […] More than 90% of patients who go through nonsurgical treatment and then surgery are able to return to sports activity.

• #60 Can Hernia Belt Prevent Surgery? – Dr Parthasarathy

  https://www.gastrosurgeonindia.com/blog/hernia-belt-or-hernia-truss/

  A hernia is an intestine coming out through a hole in the abdominal wall, and whenever the patient coughs or strains, more and more intestines bulge out. A hernia truss or belt is a strap that is worn around the groin and has thick padding or even metal in it on the front. […] The basic mechanism by which a truss works is that when the hernia is pushed inside, this belt is tightly worn, and the thick metal area or the padded area presses as a stopper on the hole of the hernial defect and thereby keeps the hernia inside and prevents the hernia from popping out whenever the patient coughs or strains. This is how the truss was designed. This was once very popular. […] Even though the mechanism looks very simple, it can cause more trouble than good. […] A truss is not an alternative to surgery. The only effective treatment for hernias is surgical repair. A truss is only a temporary bridge when surgery is not possible immediately. […] A hernia truss or a hernia belt is not useful before an operation, but an abdominal binder, which is a different type of belt, is extremely useful for patients who are recovering from a major abdominal surgery or a major ventral hernia surgery.

• #61 Sports Hernia (Athletic Pubalgia) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

  A sports hernia will usually cause severe pain in the groin area at the time of the injury. The pain typically gets better with rest but comes back when you return to sports activity, especially with twisting movements. […] A common sign of sports hernia is pain during a resisted sit-up. […] In many cases, 4 to 6 weeks of physical therapy will resolve any pain and allow an athlete to return to sports. If, however, the pain comes back when you resume sports activities, you may need to consider surgery to repair the torn tissues. […] Surgery to repair the torn tissues in the groin can be done as a traditional, open procedure with one long incision or an endoscopic procedure. […] More than 90% of patients who go through nonsurgical treatment and then surgery are able to return to sports activity.

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