November 20, 2025 Author : Juliana Oliveira (general surgery) An abdominal wall hernia is a protrusion of intra-abdominal content (tissues, organs, most frequently the intestine) through a weak point in the abdominal wall. The abdominal wall is not as rigid as the name initially suggests. It is composed of muscles that extend from the lower limit of the ribs in the upper side, to the hip bones, inferiorly, and posteriorly to the spine; These muscles are arranged in different layers and with different orientations; Together they ensure the dynamic capacity and flexibility of the abdominal wall. A weakness in the abdominal wall can be: Congenital, when present at birth; Acquired, when it occurs at any time throughout life, due to an increase in an area of fragility, in points that are already more fragile in the abdominal wall. Hernias can also be: Primary, when they occur without any prior intervention at the site where they appear; Incisional hernias, when they occur in areas that have been surgically treated, causing a new weakness in the abdominal wall. Location of abdominal wall hernias Abdominal wall hernias can appear in various locations. Location of primary hernias Subxiphoid : immediately below the xiphoid process, which is the lower end of the sternum. Epigastric : near the stomach. Umbilical : around the navel. Infraumbilical : below the navel. Suprapubic : above the pubic bone. Inguinal : above the inguinal ligament, more common in men. Femoral : below the inguinal ligament, more common in women. Spiegel : on the side between the navel and the pelvic bone. Lumbar : in the back, in the lumbar region. Location of incisional hernias Incisional hernias can occur in any location on the abdominal where there is a scar from a surgical incision. Risk factors for abdominal wall hernias Abdominal wall hernias are more common in men, and inguinal hernias are the most frequent. Risk factors are well identified: Factors that increase abdominal pressure such as obesity, pregnancy, chronic cough, chronic constipation, and repeated or single high-intensity efforts; Factors that weaken the abdominal wall such as collagen diseases, aging and loss of muscle strength, malnutrition, smoking, chronic medication (e.g., corticosteroid therapy), and previous incisions. Symptoms and diagnosis of abdominal wall hernia In most cases, a protrusion is felt at the site of the hernia, which increases with exertion, and which may cause some discomfort and pain . It is reducible when it becomes less evident or even disappears (reduces) with rest or by applying some manual pressure. Conversely, an irreducible hernia is one in which the herniated contents cannot be restored within the abdominal cavity. Hernias can also be incoercible , when, despite being able to reduce, the contents quickly protrude again through the hernial orifice. Irreducible hernias can become: Incarcerated (trapped) in the orifice through which the contents protrude outside the abdominal cavity; Strangulated if vascularization of the herniated content is compromised. A strangulated hernia can lead to ischemia (and necrosis or death) of the herniated contents, usually the intestine, so it is a surgical emergency. In this case, nausea or vomiting, increased abdominal distension, decreased gas and stool passage, and local pain and inflammation may occur. The evaluation in a general surgery consultation of a patient complaining of swelling in the abdominal wall almost always results in a diagnosis of hernia. However, in most cases, it will be necessary to perform some medical tests to clarify doubts. According to the most recent guidelines, and especially in more complex hernias, computed tomography (CT) is chosen to obtain the best definition of the hernial orifice, the muscles involved, and the hernial contents, thus allowing for better surgical planning. Treatment of abdominal wall hernias An abdominal wall hernia always requires surgery because: It is not reversible without treatment; It can compromise the blood supply to the contents of the hernia itself; It can cause other complications such as intestinal obstructions. Incarcerated or strangulated hernias require even more urgent surgery. Hernias that do not cause symptoms (asymptomatic) may not require immediate surgical intervention. Preoperative optimization If there is no emergency context, optimizing the patient's conditions before surgery contributes to ensure the best results. It involves controlling risk factors to minimize postoperative complications such as infections, hematomas, and long-term recurrence. Thus, interventions recommended can be: Promoting weight loss; Following a smoking cessation program; Optimizing the control of chronic diseases, such as diabetes; Motor and functional rehabilitation of the abdominal wall with physiotherapy; Botulinum toxin (Botox) injections into the abdominal wall to increase flexibility and reduce pressure in cases of very large ventral hernias. Surgical approach In most cases, the definitive treatment of an abdominal hernia involves surgery, most often with the placement of a prosthesis or mesh, which reduces the risk of recurrence. The type of surgery depends on the location of the hernia, its size, and factors associated with the patient, such as comorbidities, previous surgeries, among others. There are two types of surgical approach : Open, conventional, or anterior approach; Minimally invasive or laparoscopic, which is preferred whenever technically possible. Laparoscopy is less invasive because, in most cases, it uses three small incisions (1 cm or less) in the abdominal wall to access the abdominal cavity. A camera allows the hernia to be identified, its contents reduced, and an internal prosthesis applied. In addition, since it is possible to visualize the entire abdominal wall internally, it is possible to identify other hernias that may exist and correct them in the same surgical procedure. This is especially true for small inguinal and femoral hernias, which may be underdiagnosed on physical examination. With laparoscopy, recovery is less painful, the return to active life is faster, the risk of surgical wound complications—for example, seromas (fluid collections), hematomas, and infections—is lower, and the aesthetic result is more satisfactory. Post-operative care and follow-up The main local complications are: Immediate: infections and hematomas of the surgical wound; Long-term: chronic pain and recurrence. Post-operative recovery for operated patients is rapid . They are encouraged to get out of bed and walk early. Most are discharged in less than 24 hours. Wound care is performed on an outpatient basis, and sutures are usually removed by the day 12, followed by reassessment in a general surgery consultation. In some cases, the use of an abdominal support belt may be indicated during the first post-operative month. The patient is encouraged to resume their professional activity as early as possible, in the first post-operative month. In general, regular physical activity can be resumed between the first and second post-operative month. Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
