What is a Hernia?
Many people ask us: what is a hernia? The word hernia is derived from Latin, roughly meaning “protrusion of contents of a body cavity, through the lining of that cavity”. The abdomen is a cavity which has several areas of weakness where a hernia can occur. For example, when the stomach pushes into the chest cavity, this condition is called a hiatal hernia. There are many other types of abdominal hernias. In our practice, we focus on inguinal hernia and umbilical hernia.
Abdominal wall hernias are the most common types of hernias that general surgeons take care of. Many surgeons repair all kinds of hernias, while some choose to focus on specific types of hernias.
Inguinal and Femoral Hernia
The most common abdominal wall hernia, and the one that we focus on primarily, is a groin hernia or inguinal hernia. Three possible types of hernias fall into this category, including indirect inguinal hernia, direct inguinal hernia and femoral hernia. In each of these hernias, abdominal contents such as intestine, bladder, or fat herniate through a hole in the abdominal wall into the groin and occasionally down into the scrotum or labia. Because the holes are in the lower abdomen, these hernias are most noticeable and symptomatic when people stand, sit, or cough.
The human anatomy of the groin is complex, involving many different muscles, blood vessels, and nerves. In men, there is also the spermatic cord, which contains nerves and blood vessels that travel to the testicle. Because of the complexity, groin hernia surgery is not always straightforward, and great outcomes from surgery are not guaranteed. Currently about 1 in 8 people who undergo inguinal hernia surgery in the United States experience some level of chronic pain as a result of surgery. We specialize in inguinal hernia, because there are best practices that allow for a much lower incidence of chronic pain. The two inguinal hernia repairs that we perform – mesh and non mesh – offer the lowest incidence of chronic pain, while having excellent long term success rates.
Umbilical and Epigastric Hernia
Umbilical hernias and epigastric hernias are also very common. They result from a very small opening in the front of the abdomen. Typically, most people are born with a very small hole that stretches out over their lifetime. This can occur as a result of aging, weight gain or pregnancy. Once the hole is large enough, abdominal fat, and less frequently intestine, can herniate out of this hole. Since gravity is not pushing abdominal contents out of these types of hernias, they are less dangerous.
Incisional hernias occur as a result of previous surgical incisions of the abdomen. These can range in size from small hernias, like umbilical hernias, to much larger and more complex hernias.
About Dr. Reinhorn & Dr. Fullington
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. He started his practice as a general surgeon in 2001, and in 2012 he transitioned to focus on the care of hernia patients. In 2018, he co-founded Boston Hernia, an ambulatory surgery practice focused exclusively on hernia surgery. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon, where she performed hundreds of laparoscopic hernia repairs, to Boston Hernia where she was intensively trained by Dr. Reinhorn in the open preperitoneal and Shouldice techniques. Together with their physician assistant team, they perform approximately 800 hernia surgeries every year. Both surgeons offer a tailored approach for each patient, taking into account individual patient factors to decide if surgery is recommended or not, what type of repair (open, laparoscopic, mesh, non-mesh) is best, and what type of anesthesia is safest. At Boston Hernia, our focus is on each individual patient and continuously improving our own surgical techniques and outcomes. We do this by participating in various hernia societies, studying our own outcomes through a national database, and publishing our data to influence the care of hernia patients nationally and internationally. Boston Hernia is an affiliate practice of the Mass General Brigham system. In addition to operating at Newton-Wellesley Hospital, a Mass General Brigham Hospital, we offer care at ambulatory surgery centers in Waltham, MA and Derry, NH.