Editing Hernia

{{short description|Abnormal exit of tissues or organs from the cavity they usually reside in}}
{{Infobox medical condition (new)
| name            = Hernia
| image           = Inguinalhernia.gif
| caption         = Diagram of an [[indirect inguinal hernia]] (view from the side)
| field           = [[General surgery]]
| symptoms        = Pain especially with coughing, bulging area<ref name=NEJM15/>
| complications   = [[Strangulation (bowel)|Bowel strangulation]]<ref name=NEJM15/>
| onset           = < 1 year and > 50 years old (groin hernias)<ref name=Dom2014/>
| duration        = 
| causes          = 
| risks           = Smoking, [[chronic obstructive pulmonary disease]], [[obesity]], [[pregnancy]], [[peritoneal dialysis]], [[collagen vascular disease]], connective tissue disease<ref name=NEJM15/><ref name=Dom2014/><ref name=BMJ2014/>
| diagnosis       = Based on symptoms, [[medical imaging]]<ref name=NEJM15/>
| differential    =
| prevention      = 
| treatment       = Observation, surgery<ref name=NEJM15/>
| medication      = 
| prognosis       = 
| frequency       = 18.5 million (2015)<ref name=GBD2015Pre/>
| deaths          = 59,800 (2015)<ref name=GBD2015De/>
}}

A '''hernia''' ({{plural form}}: '''hernias''' or '''herniae''', from [[Latin]], meaning 'rupture') is the abnormal exit of tissue or an [[organ (anatomy)|organ]], such as the [[bowel]], through the wall of the cavity in which it normally resides.<ref name=NEJM15/> The term is also used for the normal [[Development of the digestive system|development of the intestinal tract]], referring to the retraction of the intestine from the extra-embryonal [[navel]] [[coelom]] into the [[abdomen]] in the healthy embryo at about 7{{frac|1|2}} weeks.

Various types of hernias can occur,<ref name=NIHDef/> most commonly involving the [[abdomen]], and specifically the [[groin]].<ref name=NIHDef/> Groin hernias are most commonly [[inguinal hernia|inguinal]] hernias but may also be [[femoral hernia]]s.<ref name=NEJM15/> Other types of hernias include [[Hiatal hernia|hiatus]], [[incisional hernia|incisional]], and [[umbilical hernia]]s.<ref name=NIHDef>{{cite web|title=Hernia|url=https://www.nlm.nih.gov/medlineplus/hernia.html|work = MedlinePlus | publisher = U.S. National Library of Medicine |access-date=12 March 2015|date=9 August 2014|url-status=live|archive-url=https://web.archive.org/web/20150316215214/http://www.nlm.nih.gov/medlineplus/hernia.html|archive-date=16 March 2015}}</ref> Symptoms are present in about 66% of people with groin hernias.<ref name=NEJM15/> This may include pain or discomfort in the lower abdomen, especially with coughing, exercise, or [[Urination|urinating]] or [[Defecation|defecating]].<ref name=NEJM15/> Often, it gets worse throughout the day and improves when lying down.<ref name=NEJM15/> A bulge may appear at the site of hernia, that becomes larger when bending down.<ref name=NEJM15/>

Groin hernias occur more often on the right than left side.<ref name=NEJM15/> The main concern is [[Strangulation (bowel)|bowel strangulation]], where the blood supply to part of the bowel is blocked.<ref name=NEJM15/> This usually produces severe pain and tenderness in the area.<ref name=NEJM15/> Hiatus, or hiatal hernias often result in [[heartburn]] but may also cause chest pain or pain while eating.<ref name=BMJ2014>{{cite journal | vauthors = Roman S, Kahrilas PJ | title = The diagnosis and management of hiatus hernia | journal = BMJ | volume = 349 | pages = g6154 | date = October 2014 | pmid = 25341679 | doi = 10.1136/bmj.g6154 | s2cid = 7141090 }}</ref>

Risk factors for the development of a hernia include [[Tobacco smoking|smoking]], [[chronic obstructive pulmonary disease]], [[obesity]], [[pregnancy]], [[peritoneal dialysis]], [[collagen vascular disease]] and previous open [[appendectomy]], among others.<ref name=NEJM15/><ref name=Dom2014>{{cite book| vauthors = Domino FJ |title=The 5-minute clinical consult 2014|date=2014|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia, Pennsylvania|isbn=9781451188509|page=562|edition=22nd|url=https://books.google.com/books?id=2C2MAwAAQBAJ&pg=PA562|url-status=live|archive-url=https://web.archive.org/web/20170822165855/https://books.google.com/books?id=2C2MAwAAQBAJ&pg=PA562|archive-date=2017-08-22}}</ref><ref name=BMJ2014/> Predisposition to hernias is [[Genetic predisposition|genetic]]<ref name="urlEtiology of Inguinal Hernias: A Comprehensive Review">{{cite journal | vauthors = Öberg S, Andresen K, Rosenberg J | title = Etiology of Inguinal Hernias: A Comprehensive Review | journal = Frontiers in Surgery | volume = 4 | pages = 52 | year = 2017 | pmid = 29018803 | pmc = 5614933 | doi = 10.3389/fsurg.2017.00052 | doi-access = free }}</ref> and occur more often in certain families.<ref name="Whole-exome Sequencing">{{cite journal | vauthors = Mihailov E, Nikopensius T, Reigo A, Nikkolo C, Kals M, Aruaas K, Milani L, Seepter H, Metspalu A | display-authors = 6 | title = Whole-exome sequencing identifies a potential TTN mutation in a multiplex family with inguinal hernia | journal = Hernia | volume = 21 | issue = 1 | pages = 95–100 | date = February 2017 | pmid = 27115767 | pmc = 5281683 | doi = 10.1007/s10029-016-1491-9 }}</ref><ref name="urlAssociation of Collagen Type I Alpha 1 Gene Polymorphism With Inguinal Hernia - PubMed">{{cite journal | vauthors = Sezer S, Şimşek N, Celik HT, Erden G, Ozturk G, Düzgün AP, Çoşkun F, Demircan K | display-authors = 6 | title = Association of collagen type I alpha 1 gene polymorphism with inguinal hernia | journal = Hernia | volume = 18 | issue = 4 | pages = 507–512 | date = August 2014 | pmid = 23925543 | doi = 10.1007/s10029-013-1147-y | s2cid = 22999363 }}</ref><ref name="urlGenetic Study of Indirect Inguinal Hernia - PubMed">{{cite journal | vauthors = Gong Y, Shao C, Sun Q, Chen B, Jiang Y, Guo C, Wei J, Guo Y | display-authors = 6 | title = Genetic study of indirect inguinal hernia | journal = Journal of Medical Genetics | volume = 31 | issue = 3 | pages = 187–192 | date = March 1994 | pmid = 8014965 | pmc = 1049739 | doi = 10.1136/jmg.31.3.187 }}</ref><ref name=NEJM15/> [[Deleterious mutation]]s causing predisposition to hernias seem to have [[Dominance (genetics)|dominant]] inheritance (especially for men). It is unclear if groin hernias are associated with heavy lifting.<ref name=NEJM15/> Hernias can often be diagnosed based on signs and symptoms.<ref name=NEJM15/> Occasionally, [[medical imaging]] is used to confirm the diagnosis or rule out other possible causes.<ref name=NEJM15/> The diagnosis of [[hiatus hernia]]s is often done by [[endoscopy]].<ref name=BMJ2014/>

Groin hernias that do not cause symptoms in males do not need immediate surgical repair, a practice referred to as "[[watchful waiting]]".<ref name="NEJM15" /> However most men tend to eventually undergo groin hernia surgery due to the development of pain.<ref name=NEJM15/> For women, however, repair is generally recommended due to the higher rate of [[femoral hernia]]s, which have more complications.<ref name=NEJM15/> If strangulation occurs, [[surgical emergency|immediate surgery]] is required.<ref name=NEJM15/> Repair may be done by open surgery, [[laparoscopic surgery|laparoscopic surgery, or robotic-assisted surgery]].<ref name=NEJM15/> Open surgery has the benefit of possibly being done under [[local anesthesia]] rather than [[general anesthesia]].<ref name=NEJM15/> Laparoscopic surgery generally has less pain following the procedure.<ref name=NEJM15/> A hiatus hernia may be treated with lifestyle changes such as raising the head of the bed, [[weight loss]] and adjusting [[Diet (nutrition)|eating habits]].<ref name=BMJ2014/> The medications [[H2 blockers]] or [[proton pump inhibitors]] may help.<ref name=BMJ2014/> If the symptoms do not improve with medications, a surgery known as [[laparoscopic Nissen fundoplication]] may be an option.<ref name=BMJ2014/>

Globally in 2019, there were 32.53 million prevalent cases of inguinal, femoral, and abdominal hernias, with a 95% uncertainty interval ranging from 27.71 to 37.79 million. Additionally, there were 13.02 million incident cases, with an uncertainty interval of 10.68 to 15.49 million. These figures reflect a 36.00% increase in prevalent cases and a 63.67% increase in incident cases compared to the numbers reported in 1990.<ref>{{Cite journal |date=24 March 2023 |title=Trends of inguinal, femoral, and abdominal hernia from 1990 to 2019 |pmc=10389329 |last1=Ma |first1=Q. |last2=Jing |first2=W. |last3=Liu |first3=X. |last4=Liu |first4=J. |last5=Liu |first5=M. |last6=Chen |first6=J. |journal=International Journal of Surgery |location=London, England |volume=109 |issue=3 |pages=333–342 |doi=10.1097/JS9.0000000000000217 |pmid=37093073 }}</ref> About 27% of males and 3% of females develop a groin hernia at some point in their lives.<ref name=NEJM15>{{cite journal | vauthors = Fitzgibbons RJ, Forse RA | title = Clinical practice. Groin hernias in adults | journal = [[The New England Journal of Medicine]] | volume = 372 | issue = 8 | pages = 756–763 | date = February 2015 | pmid = 25693015 | doi = 10.1056/NEJMcp1404068 }}</ref> Inguinal, femoral and abdominal hernias were present in 18.5 million people and resulted in 59,800 deaths in 2015.<ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref><ref name=GBD2015De>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A | collaboration = GBD 2015 Mortality and Causes of Death Collaborators | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 }}</ref> Groin hernias occur most often before the age of 1 and after the age of 50.<ref name=Dom2014/> It is not known how commonly hiatus hernias occur, with estimates in North America varying from 10% to 80%.<ref name=BMJ2014/> The first known description of a hernia dates back to at least 1550 BC, in the [[Ebers Papyrus]] from Egypt.<ref>{{cite book| vauthors = Nigam VK |title=Essentials of Abdominal Wall Hernias|date=2009|publisher=I. K. International |isbn=9788189866938|page=6|url=https://books.google.com/books?id=oxnNODC5wVgC&pg=PA6|url-status=live|archive-url=https://web.archive.org/web/20170908153645/https://books.google.com/books?id=oxnNODC5wVgC&pg=PA6|archive-date=2017-09-08}}</ref>

== Pathogenesis ==
Most hernias happen when the muscles and tendons in the belly weaken or get damaged, which makes it hard for them to keep the insides in place and support the body properly. The belly and pelvis act like a container made of muscles, tendons and bones. When pressure builds up inside this container, the muscles push back to keep everything in place. If the pressure gets too high, it may cause the belly's wall to break, leading to a hernia. Once a hernia starts, it keeps enlarging, because the tension on the wall there increases.<ref>{{Cite journal |last1=Park |first1=Adrian E. |last2=Roth |first2=J. Scott |last3=Kavic |first3=Stephen M. |date=2006-05-01 |title=Abdominal Wall Hernia |url=https://www.sciencedirect.com/science/article/pii/S0011384006000190 |journal=Current Problems in Surgery |volume=43 |issue=5 |pages=326–375 |doi=10.1067/j.cpsurg.2006.02.004 |pmid=16679124 |issn=0011-3840}}</ref>

==Epidemiology==
About 27% of males and 3% of females develop a groin hernia at some time in their lives.<ref name="NEJM15" /> In 2013 about 25 million people had a hernia.<ref>{{cite journal |vauthors=Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, etal |date=August 2015 |title=Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 |journal=Lancet |volume=386 |issue=9995 |pages=743–800 |doi=10.1016/s0140-6736(15)60692-4 |pmc=4561509 |pmid=26063472 |collaboration=Global Burden of Disease Study 2013 Collaborators}}</ref> Inguinal, femoral and abdominal hernias resulted in 32,500 deaths globally in 2013 and 50,500 in 1990.<ref name="GDB2013">{{cite journal |vauthors=Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal |date=January 2015 |title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 |journal=Lancet |volume=385 |issue=9963 |pages=117–71 |doi=10.1016/S0140-6736(14)61682-2 |pmc=4340604 |pmid=25530442 |collaboration=GBD 2013 Mortality and Causes of Death Collaborators}}</ref> Healthcare costs associated with abdominal wall hernias account for an annual expenditure of approximately 2.5 to 3 billion dollars.<ref>Park AE, Roth JS, Kavic SM. Abdominal wall hernia. Curr Probl Surg. 2006 May;43(5):326-75. doi: 10.1067/j.cpsurg.2006.02.004. PMID 16679124.</ref>

==Signs and symptoms==
[[Image:Hernia.JPG|thumb|Frontal view of an inguinal hernia (right).]]
[[File:Umbilicalhernia.JPG|thumb|Incarcerated umbilical hernia with surrounding inflammation]]
Symptoms and signs vary depending on the type of hernia. By far the most common 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. Another common hernia involves the [[Spinal disc herniation|spinal discs]] and causes ''[[sciatica]]''. A [[hiatus hernia]] occurs when the stomach protrudes into the ''[[mediastinum]]'' through the esophageal opening in the [[Thoracic diaphragm|diaphragm]].

Hernias might manifest with pain in the area, a noticeable lump, or less specific symptoms caused by pressure on an organ stuck within the hernia, potentially leading to organ dysfunction. Typically, fatty tissue is the initial entrant into a hernia, but it might also involve an organ. Hernias are caused by a disruption or opening in the [[fascia]], or fibrous tissue, which forms the abdominal wall. It is possible for the bulge associated with a hernia to come and go, but the defect in the tissue will persist.

Symptoms may or may not be present in some [[inguinal hernia]]s. In the case of reducible hernias, a bulge in the [[groin]] or in another abdominal area can often be seen and felt. When standing, such a bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the [[scrotum]] around the [[testicular]] area.<ref>{{cite web|url=http://www.mayoclinic.com/health/inguinal-hernia/DS00364/DSECTION=symptoms|title=Inguinal hernia | work = The Mayo Clinic |access-date=2010-05-24|url-status=live|archive-url=https://web.archive.org/web/20100213003240/http://www.mayoclinic.com/health/inguinal-hernia/DS00364/DSECTION%3Dsymptoms|archive-date=2010-02-13}}</ref>

Irreducible abdominal hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation (loss of blood supply), obstruction (kinking of intestine), or both. Strangulated hernias are always painful and pain is followed by tenderness. [[Nausea]], [[vomiting]], or [[fever]] may occur in these cases due to [[bowel]] obstruction. Also, the hernia bulge, in this case, may turn red, purple or dark and pink.<ref>{{Cite web |title=What is Hernia? - Causes, Symptoms, Diagnosis |url=https://www.pristyncare.com/disease/hernia/ |access-date=2023-12-16 |website=www.pristyncare.com |language=en}}</ref>

In the diagnosis of abdominal hernias, [[Medical imaging|imaging]] is the principal means of detecting internal diaphragmatic and other nonpalpable or unsuspected hernias. [[CT scan|Multidetector CT]] (MDCT) can show with precision the anatomic site of the hernia sac, the contents of the sac, and any complications. MDCT also offers clear detail of the abdominal wall allowing wall hernias to be identified accurately.<ref>{{cite journal |vauthors=Lee HK, Park SJ, Yi BH |title=Multidetector CT reveals diverse variety of abdominal hernias |journal=Diagnostic Imaging |volume=32 |issue=5 |pages=27–31 |year=2010 |url=http://www.diagnosticimaging.com/ct/content/article/113619/1575055 |url-status=dead |archive-url=https://web.archive.org/web/20100618055724/http://www.diagnosticimaging.com/ct/content/article/113619/1575055 |archive-date=2010-06-18 |access-date=2010-06-25 }}</ref>
[[File:Adult male inguinal hernia reduced.gif|thumb|[[Inguinal hernia]]. By pushing on the hernia, it can be (reduced) pushed into the abdomen. When the pressure is removed, the hernia quickly reappears.]]

=== Complications ===
Untreated hernia may be complicated by:
* [[Inflammation]]
* [[Bowel obstruction|Obstruction]] of any lumen, such as [[bowel obstruction]] in intestinal hernias
* [[Strangulation (bowel)|Strangulation]]
* [[Hydrocele]] of the hernial sac
* [[Haemorrhage|Hemorrhage]]
* [[Autoimmune]] problems
* [[Reduction (orthopedic surgery)|Irreducibility]] or incarceration, in which it cannot be reduced, or pushed back into place,<ref name="WashingtonSurgery2008">{{cite book | vauthors = Goers TA, Klingensmith ME, Chen LE, Glasgow SC |title=The Washington manual of surgery |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |location=Philadelphia |year=2008 |isbn=978-0-7817-7447-5 }}</ref> at least not without very much external effort.<ref>{{cite web | url = http://onlinedictionary.datasegment.com/word/incarcerated | work = onlinedictionary.datasegment.com | title = Incarcerated | archive-url = https://web.archive.org/web/20081120045818/http://onlinedictionary.datasegment.com/word/incarcerated | archive-date=2008-11-20 }} Citing: Webster 1913</ref> In intestinal hernias, this also substantially increases the risk of bowel obstruction and strangulation.

==Causes==
Causes of hiatus hernia vary depending on each individual. Among the multiple causes, however, are the mechanical causes which include: improper heavy weight lifting, hard [[coughing]] bouts, sharp blows to the abdomen, and incorrect [[Human position|posture]].<ref>{{cite web|url=http://inguinalhernia.us/hiatal-hernia-causes.html| title=Hiatal Hernia Symptoms, Causes And Relation To Acid Reflux And Heartburn|access-date=2010-05-24 |archive-date=October 28, 2008 |archive-url= https://web.archive.org/web/20081028010841/http://www.inguinalhernia.us/hiatal-hernia-causes.html }}</ref> 
[[File:Hernia Common Sites.png|thumb|271x271px|Common sites for hernias]]
Furthermore, conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination (constipation, [[enlarged prostate]]), [[chronic obstructive pulmonary disease|chronic lung disease]], and also, fluid in the abdominal cavity ([[ascites]]).<ref>{{cite web | vauthors =  Balentine JR | veditors = Stöppler MC | date = | work = eMedicineHealth.com | publisher = WebMD |url= http://www.emedicinehealth.com/hernia/page2_em.htm |title=Hernia Causes |access-date=2010-05-24 |url-status=live |archive-url =https://web.archive.org/web/20100531073222/http://www.emedicinehealth.com/hernia/page2_em.htm |archive-date=2010-05-31}}</ref>

Also, if muscles are weakened due to [[poor nutrition]], [[smoking]], and [[overexertion]], hernias are more likely to occur.

The physiological school of thought contends that in the case of [[inguinal hernia]], the above-mentioned are only an [[anatomical]] symptom of the underlying [[physiological]] cause. They contend that the risk of hernia is due to a physiological difference between patients who have hernia and those who do not, namely the presence of [[aponeurotic]] extensions from the [[transversus abdominis]] aponeurotic arch.<ref>{{cite journal | vauthors = Desarda MP | title = Surgical physiology of inguinal hernia repair--a study of 200 cases | journal = BMC Surgery | volume = 3 | pages = 2 | date = April 2003 | pmid = 12697071 | pmc = 155644 | doi = 10.1186/1471-2482-3-2 | doi-access = free }}</ref> There isn't any proof that being physically active will cause a hernia to get stuck or make an existing hernia worse.<ref>{{Cite journal |last1=Montgomery |first1=John |last2=Dimick |first2=Justin B. |last3=Telem |first3=Dana A. |date=2018-09-11 |title=Management of Groin Hernias in Adults-2018 |url=https://pubmed.ncbi.nlm.nih.gov/30128503/ |journal=JAMA |volume=320 |issue=10 |pages=1029–1030 |doi=10.1001/jama.2018.10680 |issn=1538-3598 |pmid=30128503|s2cid=205095374 }}</ref>

Abdominal wall hernia may occur due to trauma. If this type of hernia is due to blunt trauma it is an emergency condition and could be associated with various solid organs and hollow viscus injuries.

==Diagnosis==

===Inguinal===
{{main article|Inguinal hernia}}

[[File:USofaninguinherniaMark.png|thumb|Ultrasound showing an inguinal hernia]]
[[File:Inquinalhernia.png|thumb|An incarcerated inguinal hernia as seen on CT]]
[[File:Colonic Herniation 08787.jpg|thumb|X-ray of colonic herniation]]
By far the most common hernias (up to 75% of all abdominal hernias) are inguinal hernias, which are further divided into the more common [[indirect inguinal hernia]] (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the [[direct inguinal hernia]] type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal. An [[indirect inguinal hernia]]  and a  [[direct inguinal hernia]] can be distinguished by their positioning in relation to the inferior epigastric vessels. An indirect hernia is situated laterally to these vessels, whereas a direct hernia is positioned medially to them. Inguinal hernias are the most common type of hernia in both men and women. In some selected cases, they may require [[inguinal hernia surgery|surgery]].

There are special cases where a direct and indirect hernia appear together. A [[pantaloon hernia]] (or saddlebag hernia) is a combined direct and indirect hernia when the hernial sac protrudes on either side of the [[inferior epigastric vessels]].

Additionally, though very rare, two or more indirect hernias may appear together such as in a [[double indirect hernia]].<ref name="JPSCR13">{{cite journal| vauthors = Jones R |title=An unexpected finding during an inguinal herniorrhaphy: report of an indirect hernia with two hernia sacs|journal=Journal of Pediatric Surgery Case Reports |date=2013 |volume=1 |issue=10 |pages=331–332 |doi=10.1016/j.epsc.2013.09.002 |doi-access=free}}</ref>

===Femoral===
{{main article|Femoral hernia}}

Femoral hernias occur just below the [[inguinal ligament]], when abdominal contents pass into the weak area at the posterior wall of the [[femoral canal]]. They can be hard to distinguish from the inguinal type (especially when ascending cephalad){{clarify|date=October 2021}}: however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and [[inguinal hernia]].

A ''Cooper's hernia'' is a femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing almost immediately beneath the skin.

===Umbilical===
{{main article|Umbilical hernia}}

They involve protrusion of intra-abdominal contents through a weakness at the site of passage of the [[umbilical cord]] through the [[abdominal wall]]. 
Umbilical hernias in adults are largely acquired, and are more frequent in [[obese]] or [[pregnant]] women. Abnormal [[decussation]] of fibers at the [[Linea alba (abdomen)|linea alba]] may be a contributing factor.

===Incisional===
{{main article|Incisional hernia}}

An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median [[laparotomy]] incisions in the [[Linea alba (abdomen)|linea alba]], they are termed [[ventral hernia]]s. These occur in about 13% of people at 2 years following surgery.<ref>{{cite journal | vauthors = Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JC, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J | display-authors = 6 | title = Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients | journal = PLOS ONE | volume = 10 | issue = 9 | pages = e0138745 | date = 2015 | pmid = 26389785 | pmc = 4577082 | doi = 10.1371/journal.pone.0138745 | bibcode = 2015PLoSO..1038745B | doi-access = free }}</ref>

===Diaphragmatic===
{{main article|Diaphragmatic hernia}}

[[File:Hiatalhernia.gif|thumb|Diagram of a [[hiatus hernia]] ([[Anatomical position|coronal section]], viewed from the front).]]
Higher in the abdomen, an (internal) "diaphragmatic hernia" results when part of the stomach or intestine protrudes into the [[Thoracic cavity|chest cavity]] through a defect in the diaphragm.

A [[hiatus hernia]] is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach ([[Diaphragm (anatomy)|esophageal hiatus]]) serves as a functional "defect", allowing part of the [[stomach]] to (periodically) "herniate" into the chest. Hiatus hernias may be either "''sliding''", in which the [[Esophagus|gastroesophageal junction]] itself slides through the defect into the [[chest]], or non-sliding (also known as ''para-esophageal''), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised.

A [[congenital diaphragmatic hernia]] is a distinct problem, occurring in up to 1 in 2000 births, and requiring [[pediatric surgery]]. Intestinal organs may herniate through several parts of the [[diaphragm (anatomy)|diaphragm]], posterolateral (in [[Bochdalek's triangle]] (lumbocostal triangle), resulting in a [[Bochdalek hernia]]), or anteromedial-retrosternal (in the cleft of [[foramina of Morgagni]] (sternocostal triangle), resulting in a [[Morgagni's hernia]]).<ref name="pmid19527083">{{cite journal | vauthors = Arráez-Aybar LA, González-Gómez CC, Torres-García AJ | title = Morgagni-Larrey parasternal diaphragmatic hernia in the adult | journal = Revista Espanola de Enfermedades Digestivas /| volume = 101 | issue = 5 | pages = 357–66 | date = May 2009 | pmid = 19527083 | url = http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=461435&TO=RVN&Eng=1 }}</ref>

===Other hernias===
Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and [[eponyms]]. The above article deals mostly with "visceral hernias", where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:
*[[Abdominal wall]] hernias:
**[[Umbilical hernia]]
**[[Epigastric hernia]]: a hernia through the [[Linea alba (abdomen)|linea alba]] above the [[Navel|umbilicus]].
**[[Spigelian hernia]], also known as spontaneous lateral ventral hernia
*[[Amyand's hernia]]: containing the appendix vermiformis within the hernia sac
*[[Brain herniation]], sometimes referred to as brain hernia, is a potentially deadly side effect of very high [[intracranial pressure]] that occurs when a part of the [[human brain|brain]] is squeezed across structures within the [[human skull|skull]].
*[[Broad ligament hernia]], of the uterus.<ref>{{cite journal | vauthors = Ozben V, Aliyeva Z, Barbur E, Guler I, Karahasanoglu T, Baca B | title = Laparoscopic management of incarcerated broad ligament hernia in a patient with bilateral parametrium defects - a video vignette | journal = Colorectal Disease | volume = 22 | issue = 9 | pages = 1197–1198 | date = September 2020 | pmid = 32180330 | doi = 10.1111/codi.15039 | s2cid = 212739555 }}</ref><ref>{{cite journal | vauthors = Hiraiwa K, Morozumi K, Miyazaki H, Sotome K, Furukawa A, Nakamaru M | title = Strangulated hernia through a defect of the broad ligament and mobile cecum: a case report | journal = World Journal of Gastroenterology | volume = 12 | issue = 9 | pages = 1479–80 | date = March 2006 | pmid = 16552826 | pmc = 4124335 | doi = 10.3748/wjg.v12.i9.1479 | doi-access = free }}</ref>
*[[Double indirect hernia]]: an indirect inguinal hernia with two hernia sacs, without a concomitant direct hernia component (as seen in a pantaloon hernia).<ref name="JPSCR13" />
*[[Hiatus hernia]]: a hernia due to "short oesophagus" — insufficient elongation — stomach is displaced into the thorax
*[[Littre Hernia|Littre's hernia]]: a hernia involving a [[Meckel's diverticulum]]. It is named after the French anatomist [[Alexis Littré]] (1658–1726).
*[[Lumbar]] hernia: a hernia in the lumbar region (not to be confused with a [[Spinal disc herniation|lumbar disc hernia]]), contains the following entities:
**[[Petit's hernia]]: a hernia through Petit's triangle (inferior lumbar triangle). It is named after French surgeon  [[Jean Louis Petit]] (1674–1750).
**[[Grynfeltt's hernia]]: a hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (1840–1913).
*[[Maydl's hernia]]: two adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic.
*[[Obturator hernia]]: hernia through [[obturator canal]]
[[File:Colostomy and parastomal hernia.JPG|thumb|Patient with a [[colostomy]] complicated by a large parastomal hernia.]]
*Parastomal hernias, which is when tissue protrudes adjacent to a [[stoma (medicine)|stoma]] tract.
*[[Paraumbilical hernia]]: a type of umbilical hernia occurring in adults
*[[Perineal hernia]]: a perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
*Properitoneal hernia: rare hernia located directly above the [[peritoneum]], for example, when part of inguinal hernia projects from the [[deep inguinal ring]] to the preperitoneal space.
*[[Retrocolic hernia]]: entrapment of portions of the small intestine behind the [[mesocolon]].
*[[Richter's hernia]]: a hernia involving only one sidewall of the bowel, which can result in bowel strangulation leading to perforation through ischaemia without causing [[bowel obstruction]] or any of its warning signs. It is named after German surgeon [[August Gottlieb Richter]] (1742–1812).
*[[Sliding hernia]]: occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. The [[Colon (anatomy)|colon]] and the [[urinary bladder]] are often involved. The term also frequently refers to [[sliding hernias of the stomach]].
*Sciatic hernia: this hernia in the [[greater sciatic foramen]] most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of [[sciatic]] neuralgia.
*[[Sports hernia]]: a hernia characterized by chronic groin pain in athletes and a dilated [[superficial inguinal ring]].
*[[Tibialis anterior hernia]]: can present as a bulge in the shins. Pain on rest, walking, or during exercise may occur. The bulge can typically not be present unless pressure or flexing of the leg occurs.<ref>{{cite journal | vauthors = Nguyen JT, Nguyen JL, Wheatley MJ, Nguyen TA | title = Muscle hernias of the leg: A case report and comprehensive review of the literature | journal = The Canadian Journal of Plastic Surgery | volume = 21 | issue = 4 | pages = 243–7 | date = 2013 | pmid = 24497767 | pmc = 3910527 | doi = 10.1177/229255031302100408 }}</ref><ref>{{cite journal | vauthors = Masoumi A, Ramogida G | title = Tibialis anterior herniation - a rare clinical entity: a case report and review of the literature | journal = The Journal of the Canadian Chiropractic Association | volume = 64 | issue = 1 | pages = 88–91 | date = April 2020 | pmid = 32476672 | pmc = 7250514 }}</ref><ref>{{cite journal | vauthors = Sharma N, Kumar N, Verma R, Jhobta A | title = Tibialis Anterior Muscle Hernia: A Case of Chronic, Dull Pain and Swelling in Leg Diagnosed by Dynamic Ultrasonography | journal = Polish Journal of Radiology | volume = 82 | pages = 293–295 | date = 2017-05-31 | pmid = 28638493 | pmc = 5462483 | doi = 10.12659/PJR.900846 }}</ref>
*[[Velpeau hernia]]: a hernia in the groin in front of the femoral blood vessels

==Treatment==
{{Main article|Hernia repair|Inguinal hernia surgery}}

[[File:US Navy 081117-N-1512O-119 Lt. Christie Quietmeyer performs hernia repair surgery with the aid of Lt. Craig Fossee and Hospital Corpsman 3rd Class Zack Mikesell.jpg|thumb|[[Hernia repair]] being performed aboard the amphibious assault ship [[USS Bataan (LHD-5)|USS ''Bataan'']].]]

===Truss===

The benefits of the use of an external device to maintain reduction of the hernia without repairing the underlying defect (such as hernia [[Truss (medicine)|trusses]], trunks, belts, etc.) are unclear.<ref name="NEJM15" />

===Surgery===
[[File:Inguinal Hernia Patch.png|thumb|Inguinal hernia repair with mesh diagram]]
[[File:Lap-HerniaMesh-Sambalis.jpg|thumb|Laparoscopic hernia repair with mesh]]
Surgery is recommended for some types of hernias to prevent complications such as obstruction of the bowel or strangulation of the tissue, although umbilical hernias and hiatus hernias may be watched, or are treated with medication.<ref>{{cite web |url=http://www.nhs.uk/conditions/hernia/Pages/Introduction.aspx |title= Hernia | work = U.K. National Health Service |access-date=2017-07-23 |url-status=live |archive-url=https://web.archive.org/web/20170714182318/http://www.nhs.uk/conditions/hernia/Pages/Introduction.aspx |archive-date=2017-07-14 }}</ref> Most abdominal hernias can be surgically repaired, but surgery has complications. Prior to surgery patients should be medically optimized receive guidance about changing factors that can be controlled, such as quitting smoking, managing medical conditions like diabetes effectively, and working on losing weight.

Three primary methods can be utilized: open surgery, [[laparoscopy]], or robotic techniques. Fixing an inguinal hernia using [[laparoscopy]] causes less pain, speeds up recovery, and shows similar low rates of the hernia coming back compared to the traditional open repair method. However, open surgery can be done sometimes without general anesthesia. Using local anesthesia for open groin hernia repair, particularly in patients with additional health issues, leads to fewer complications and reduced costs.<ref>{{Cite journal |last1=Balentine |first1=Courtney J. |last2=Meier |first2=Jennie |last3=Berger |first3=Miles |last4=Reisch |first4=Joan |last5=Cullum |first5=Munro |last6=Lee |first6=Simon C. |last7=Skinner |first7=Celette Sugg |last8=Brown |first8=Cynthia J. |date=February 2021 |title=Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients |journal=The Journal of Surgical Research |volume=258 |pages=64–72 |doi=10.1016/j.jss.2020.08.054 |issn=1095-8673 |pmc=7968932 |pmid=33002663}}</ref> Studies show that compared to regional or general anesthesia, local anesthesia results in less postoperative pain, shorter recovery times, and decreased unplanned overnight stays.<ref>{{Cite journal |last1=van Veen |first1=Ruben N. |last2=Mahabier |first2=Chander |last3=Dawson |first3=Imro |last4=Hop |first4=Wim C. |last5=Kok |first5=Niels F. M. |last6=Lange |first6=Johan F. |last7=Jeekel |first7=Johannus |date=March 2008 |title=Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial |url=https://pubmed.ncbi.nlm.nih.gov/18376185/ |journal=Annals of Surgery |volume=247 |issue=3 |pages=428–433 |doi=10.1097/SLA.0b013e318165b0ff |issn=0003-4932 |pmid=18376185|s2cid=22487510 }}</ref> However, it might not be enough for repairing large hernias or in patients with abdominal domain loss, where general anesthesia is preferred.
{| class="wikitable"
|+'''Laparoscopic mesh surgery''', as compared to open mesh surgery
!Advantages
!Disadvantages
|-
|
* Quicker recovery<ref name=":2">{{cite book | last=Klingensmith | first=Mary E. | title=The Washington Manual of Surgery | publisher=Lippincott Williams & Wilkins | publication-place=Philadelphia | date=2008 | isbn=978-0-7817-7447-5 | page=}}</ref>
* Less pain during the first few days following the procedure
* Fewer postoperative complications such as infections, bleeding and [[seroma]]s<ref name=":3">{{Cite web |date=2004-09-22 |title=Overview {{!}} Laparoscopic surgery for inguinal hernia repair {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/TA83 |access-date=2023-11-09 |website=www.nice.org.uk}}</ref>
* Lower risk of chronic pain<ref name=":3" />
|
* Needs a surgeon who is highly experienced in inguinal hernia repair (>200 operations/year){{Citation needed|date=November 2023}}
* Longer operation time<ref name=":2" />
* Increased recurrence of primary hernias if a surgeon is not experienced enough<ref name=":2" />
|}
[[Robot-assisted surgery|Robot-assisted]] hernia surgery has also recently gained popularity as safe alternatives to open surgery. Robotic surgery for inguinal hernia repair shows outcomes comparable to laparoscopic surgery. The rates of overall complications, long-lasting postoperative pain, urinary retention, and 30-day re-admission are very similar between these two methods.<ref name=":1">{{Cite journal |last1=Solaini |first1=Leonardo |last2=Cavaliere |first2=Davide |last3=Avanzolini |first3=Andrea |last4=Rocco |first4=Giuseppe |last5=Ercolani |first5=Giorgio |date=2022 |title=Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis |journal=Journal of Robotic Surgery |volume=16 |issue=4 |pages=775–781 |doi=10.1007/s11701-021-01312-6 |issn=1863-2483 |pmc=9314304 |pmid=34609697}}</ref> Just like in other areas of general surgery, it has been noted that robotic surgery for inguinal hernia repair takes more time in the operating room compared to the laparoscopic approach.<ref name=":1" />

Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called [[Hernia repair|herniorrhaphy]]). If complications have occurred, the surgeon will check the viability of the herniated organ and remove part of it if necessary.
[[File:WBAMC first in DoD to use robot for surgery 160426-A-EK666-506.jpg|thumb|da Vinci Surgical System]]
Muscle reinforcement techniques often involve synthetic materials (a [[Inguinal hernia repair#Meshes|mesh prosthesis]]).<ref>{{cite journal | vauthors = Kamtoh G, Pach R, Kibil W, Matyja A, Solecki R, Banas B, Kulig J | title = Effectiveness of mesh hernioplasty in incarcerated inguinal hernias | journal = Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques | volume = 9 | issue = 3 | pages = 415–9 | date = September 2014 | pmid = 25337167 | pmc = 4198637 | doi = 10.5114/wiitm.2014.43080 | doi-access = free }}</ref> The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times [[Surgical staple|staples]] are used to keep the mesh in place. These [[Inguinal hernia repair#Mesh repairs|mesh repair methods]] are often called "tension free" repairs because, unlike some [[Surgical suture|suture]] methods (e.g., Shouldice), muscle is not pulled together under tension. However, this widely used terminology is misleading, as there are many [[Inguinal hernia repair#Tension-free repairs|tension-free suture methods]] that do not use mesh (e.g., Desarda, Guarnieri, Lipton-Estrin, etc.).

Evidence suggests that tension-free methods (with or without mesh) often have lower percentage of recurrences and the fastest recovery period compared to [[Inguinal hernia repair#Tension repairs|tension suture methods]]. However, the use of prosthetic mesh appears to have a higher likelihood of causing long-term pain and can also lead to infections.<ref>{{cite journal | vauthors = Sohail MR, Smilack JD | title = Hernia repair mesh-associated Mycobacterium goodii infection | journal = Journal of Clinical Microbiology | volume = 42 | issue = 6 | pages = 2858–60 | date = June 2004 | pmid = 15184492 | pmc = 427896 | doi = 10.1128/JCM.42.6.2858-2860.2004 }}</ref>

The frequency of surgical correction ranges from 10 per 100,000 (U.K.) to 28 per 100,000 (U.S.).<ref name="NEJM15" /> After elective surgery, the 30-day mortality rate for inguinal or femoral hernia repair stands at 0.1 percent, but it increases to 2.8 to 3.1 percent after urgent surgery.<ref>{{Cite journal |last1=Arenal |first1=Juan J. |last2=Rodríguez-Vielba |first2=Paloma |last3=Gallo |first3=Emiliano |last4=Tinoco |first4=Claudia |date=2002 |title=Hernias of the abdominal wall in patients over the age of 70 years |journal=The European Journal of Surgery = Acta Chirurgica |volume=168 |issue=8–9 |pages=460–463 |doi=10.1080/110241502321116451 |issn=1102-4151 |pmid=12549685|doi-access=free }}</ref> When a bowel resection is part of the hernia repair, the mortality rate is even higher.<ref>{{Cite journal |last1=Abi-Haidar |first1=Youmna |last2=Sanchez |first2=Vivian |last3=Itani |first3=Kamal M. F. |date=September 2011 |title=Risk factors and outcomes of acute versus elective groin hernia surgery |url=https://pubmed.ncbi.nlm.nih.gov/21680204/ |journal=Journal of the American College of Surgeons |volume=213 |issue=3 |pages=363–369 |doi=10.1016/j.jamcollsurg.2011.05.008 |issn=1879-1190 |pmid=21680204}}</ref> Older age, femoral hernias, female sex, and urgent repair are identified as other factors linked to a higher risk of mortality.<ref>{{Cite journal |last1=Nilsson |first1=Hanna |last2=Stylianidis |first2=Georgios |last3=Haapamäki |first3=Markku |last4=Nilsson |first4=Erik |last5=Nordin |first5=Pär |date=April 2007 |title=Mortality after groin hernia surgery |journal=Annals of Surgery |volume=245 |issue=4 |pages=656–660 |doi=10.1097/01.sla.0000251364.32698.4b |issn=0003-4932 |pmc=1877035 |pmid=17414617}}</ref>

'''<big>Post-Operative Complications</big>'''

Some complications from surgery in order of prevalence include a [[seroma]]/[[hematoma]] formation, urinary retention, [[neuralgia]]s, testicular pain/swelling, mesh infection/wound infection, and recurrence.<ref name=":0">{{Cite journal |last1=Chowbey |first1=Pradeep K |last2=Pithawala |first2=Murtaza |last3=Khullar |first3=Rajesh |last4=Sharma |first4=Anil |last5=Soni |first5=Vandana |last6=Baijal |first6=Manish |date=September 2006 |title=Complications in groin hernia surgery and the way out |journal=Journal of Minimal Access Surgery |volume=2 |issue=3 |pages=174–177 |doi=10.4103/0972-9941.27734 |issn=0972-9941 |pmc=2999781 |pmid=21187992 |doi-access=free }}</ref> A seroma is often seen after an indirect hernia repair and resolves spontaneously over 4–6 weeks. To prevent a seroma it's important to reduce the amount of cutting around the hernia sac where it's connected to the cord structures.<ref name=":0" /> Additionally, securely attaching the hernia sac to the pubic bone and creating small openings in the tissue around a direct hernia can help.<ref name=":0" /> In cases of heavy bleeding or extensive cutting, certain surgeons may opt to insert a drain.<ref name=":0" /> Urinary retention is often seen in elderly patients, these patients can be catheterized prior to surgery if there is a risk.<ref name=":0" /> Other complications may arise [[Surgery#Postoperative care|post-operatively]], including rejection of the [[Surgical mesh|mesh]] that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localized swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed. A surgically treated hernia can lead to complications such as [[inguinodynia]].

===Recovery===
Many patients are managed through [[day surgery]] centers and are able to return to work within a week or two, though intense activities are prohibited for a longer period. People who have their hernias repaired with mesh often recover within a month, but pain can last longer. Surgical complications may include pain that lasts more than three months, surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence. Pain that lasts more than three months occurs in about 10% of people following hernia repair.<ref name="NEJM15" />

==References==
{{Reflist}}

== External links ==
{{Medical condition classification and resources
|DiseasesDB     = 
|ICD10          = {{ICD10|K|40||k|40}}-{{ICD10|K|46||k|40}}
|ICD9           = {{ICD9|550}}-{{ICD9|553}}
|ICDO           = 
|OMIM           = 
|MedlinePlus    = 000960
|eMedicineSubj  = emerg
|eMedicineTopic = 251
|eMedicine_mult ={{eMedicine2|ped|2559}}
|MeshID         = D006547
}}
{{wiktionary|hernia}}
{{commons category|Hernias}}
* {{cite web | url = https://medlineplus.gov/hernia.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = hernia }}

{{Gastroenterology}}
{{Congenital abdominal wall defects}}

{{Authority control}}

[[Category:Disorders of fascia]]
[[Category:Congenital disorders of musculoskeletal system]]
[[Category:Hernias| ]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Acute pain]]
[[Category:Wikipedia emergency medicine articles ready to translate]]