Inguinal

Indirect inguinal hernias are the most common hernias in both men and women. They result from a widening of a natural hole that allows for the passage of the spermatic cord (men) or the round ligament (women). There is a genetic predisposition to these hernias. They tend to open up with increases in abdominal pressure.

Sometimes, inguinal hernias are hard to palpate on exam, i.e., there is no visible or palpable bulge or “impulse.” There may still be a hernia there. These are called occult or hidden hernias. We see them more often among women.

Direct inguinal hernias occur in older patients and is a result of weakening of the tissues, specifically the transversalis fascia.

Dr Towfigh shares tips and tricks for the perfect robotic inguinal hernia repair

Femoral

These are rare hernias that are more often seen among women. They tend to be small and are the most likely hernias to cause incarceration or strangulation, i.e., trapping of intestine. In fact, 1/3 of all femoral hernias are repaired as emergencies and may include intestinal surgery.

We check all women for femoral hernias. Also, we recommend all known femoral hernias be repaired. Watchful waiting is discouraged.

Watch Dr. Towfigh robotically repair a revisional femoral hernia.

Obturator

These are even rarer hernias. They are very hard to diagnose, too. We see these typically in thin elderly women and they are often only found incidentally on imaging. They may cause pain in the lower groin, up in the perineum, especially with internal rotation of the hip. Though rare, we have experience in diagnosis and repairing these hernias using laparoscopic or robotic-assisted techniques.

Ventral

This nomenclature is a catch-all phrase for all abdominal wall hernias, but not groin hernias.

Umbilical

Umbilical hernias are the most common type of ventral hernia. It is a reopening of the site of the umbilical cord.

Epigastric

Found just 1/2 inch above the belly button or halfway between the belly button and lower chest bone, or xiphoid. Most of these do not cause pain.

Spigelian

These are rare. They occur on the left or right side of the lower abdomen, about two finger breadths below the belly button level. Most people do not know they have one until it causes pain or intestine is stuck in it. We often use laparoscopic or robotic-assisted technique to repair these.

Flank/Back

Even rarer hernias are the flank or back hernias. These include the Petit or Grynfeltt hernias. Because of our niche in hernias, we have experience in repairing these hernias.

Incisional 

These are hernias that occur at the site of an incision. All abdominal and flank incisions are prone to hernia development. Whether a hernia occurs is based on the surgical technique to close the incision and risk factors for hernia formation.

One under-appreciated risk factor for incisional hernia is a wound infection. Wound infections prevent healing and thus incisional hernias have a higher chance of occurring.

Sports Hernia, Athletic Pubalgia, Inguinal Disruption Injury

A rose by any other name… The term Sports Hernia is a misnomer. It is not a true hernia. This is why we prefer to use Inguinal Disruption Injury. These are tears of the muscle or fascia of their bony insertion in the inguinal region. Tears can be from the rectus muscle off the pubic bone, the adductor muscle off the pubic bone, or a combination. They are painful, but usually not debilitating.

These tears typically occur in athletes or others who have disproportionately large strong muscles of the rectus or thighs. Some have an imbalance of strong muscles, such as large quads but not as strong hamstrings. When these are engaged and overstretched, they are at risk for tearing off their insertion sites. We see this with hockey players and soccer players.

It is incorrect to call a non-palpable inguinal hernia a sports hernia. These are occult or hidden hernias and they are true hernias. They are often anatomically an indirect inguinal hernia. We see these among women more often than with men.

Diastasis means separation. Diastasis recti is a separation between the left and right rectus muscles (your six-pack or abs). There may be a genetic predisposition. It is also seen after pregnancy, especially second baby or with twins/triplets. Diastasis recti is not a true hernia. There is no hole. Thus, closure is not considered necessary for medical reasons.

We recommend surgical closure of diastasis recti if there is also a hernia within the diastasis. We notice that closing the diastasis will improve the outcomes of the hernia repair. We provide our patients with the best cosmetic outcome for their hernia repair. Closure of the diastasis will help reproduce a flatter abdomen.

A tummy tuck or abdominoplasty is the classic closure technique for a rectus diastasis. We offer robotic-assisted laparoscopic diastasis closure which is virtually scar-free. Inquire to see if you are a candidate for this procedure.

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