A hernia occurs when tissue, such as a part of the intestine, pushes through a weak spot or opening in the surrounding muscle or connective tissue wall. This protrusion typically creates a noticeable bulge, most often in the abdominal area. This weakness can be congenital or develop over time from strain. A person can definitively have two hernias simultaneously.
The Likelihood of Synchronous Hernias
The medical reality of having two or more hernias at the same time is not uncommon. These are medically termed “synchronous” hernias, meaning they manifest concurrently. This is distinct from a “metachronous” hernia, which develops sequentially after a prior repair of a first hernia.
The presence of multiple hernias often points to a generalized predisposition, rather than just an isolated weak point. Many individuals have an inherent weakness in their connective tissues, which makes several areas of the abdominal wall vulnerable to failure. This foundational weakness is then compounded by factors that increase internal pressure on the abdomen.
Chronic strain is a major contributing factor to developing multiple weak spots. Persistent coughing, straining during bowel movements due to constipation, or engaging in heavy physical labor all place continuous stress on the abdominal wall. Conditions such as obesity also elevate intra-abdominal pressure, stretching the tissue. The same forces that cause one hernia can easily cause another in a separate, predisposed location.
Identifying Common Combinations
The most frequent example of multiple hernias is a bilateral hernia, specifically in the groin area. This involves an inguinal hernia on both the left and right sides of the lower abdomen. Because the anatomical structures on both sides are subject to the same systemic pressures, a weakness often develops symmetrically.
Another common pairing involves different hernia types, such as an inguinal hernia combined with an umbilical hernia. The umbilical hernia develops at the belly button, a naturally weak spot from birth. When combined with a groin hernia, this represents two distinct areas of the abdominal wall succumbing to the same pressure-related stress.
Less common are combinations like an incisional hernia paired with a hiatal hernia. An incisional hernia develops at the site of a previous surgical scar on the abdominal wall. A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity. These two can be associated in patients who share systemic risk factors, such as obesity or previous extensive abdominal surgery.
Surgical Strategy for Multiple Repairs
When a patient is diagnosed with one hernia, medical professionals often look closely for others, as they may be present but asymptomatic. Imaging studies, such as computed tomography (CT) scans, are frequently used to evaluate the abdominal wall for any hidden hernias before surgery. The detection of multiple hernias necessitates a comprehensive treatment plan that addresses all identified defects.
Surgeons generally prefer to repair all synchronous hernias during a single operative session. This approach minimizes the patient’s overall recovery time, reduces the cost associated with multiple hospital stays, and avoids the risk of a second hernia becoming complicated later.
The decision between an open repair and a minimally invasive, laparoscopic approach is often influenced by the presence of multiple sites. Laparoscopic surgery, which uses small incisions and a camera, is frequently the preferred technique for bilateral hernias. This method allows the surgeon to repair both groin defects using the same initial access points, avoiding two separate, larger incisions. While open surgery remains an option for complex defects, the reduced pain and quicker return to activity associated with the laparoscopic technique make it advantageous for simultaneous, multi-site repairs.