When hernias occur in the midline of the abdomen, they are known as midline hernias. They are only second to the most frequent groin hernias. Midline hernias occur just adjacent to the umbilicus and are considered very complex. They are small and a direct result of poor healing of an incisional hernia from a prior surgery. When a wound in the abdominal wall does not heal, the underlying intestine protrudes through the defect resulting in a hernia. The defect can be large and require careful evaluation. In such cases the muscles are deficient and expert surgical intervention and reconstruction may be required.
Minimally invasive repair
Small midline hernias are repaired with a MAS approach. First 3 ports are placed on the patients left side. A mesh is then placed over the hernial defect in the abdomen and stapled. The patient can return home the very same day. Minimal postoperative pain and infections occur with minimally invasive repair surgeries.
There are four types of midline hernia (though diastasis is not a hernia but classified as a midline malignancy)
Ventral hernia As a result of acute fascial separations in the postoperative period, ventral hernias are also called incisional hernias due to their tendency to occur at the site of past healed surgical incisions. When a ventral hernia is strangulated, the intestinal tissues are twisted within it. This situation is a medical emergency.
Epigastric hernia This type of hernia develops in the epigastrium, which is the upper central part of the abdomen. The hernia traps tissues and fat in the opening of the hernia resulting in significant tissue damage and pain. Epigastric hernia is known to be prevalent only in 10% with a fewer symptomatic cases. The most likely theory for the pathogenesis of this hernia is tension experienced by the diaphragm in the epigastric region.
Diastasis recti This is also known as abdominal separation when there is a gap of > 2.7 cm between the rectus abdominis muscle. The linea alba, which is a connective collagen sheath, is stretched resulting in the distance. Diastasis normally occurs in infants and in pregnant women.
Supraumbilical hernia Also known as paraumbilical hernia, this occurs when the mesenteric bowel pushes itself through the weak point of the ligaments. Located near the navel, a lump is formed and visualized when the fatty tissue is trapped in the area.