A hernia occurs when an organ or tissue pushes through a weak spot in the muscle or connective tissue that normally holds it in place. This typically creates a visible bulge, most often in the abdominal wall or groin area. The term “double hernia” refers to the presence of two separate hernias at the same time. This condition may involve two distinct hernias in different locations or two instances of the same type of hernia occurring simultaneously on both the left and right sides of the body.
What Constitutes a Double Hernia?
The medical community defines a double hernia in one of two ways: as a bilateral hernia or as concurrent hernias. A bilateral hernia involves the same type of defect occurring on both the right and left sides of the body, with the bilateral inguinal hernia being the most frequent example, affecting both sides of the groin.
The second, less common presentation involves two different types of hernias occurring simultaneously in separate anatomical regions. For instance, a person might have an inguinal hernia in the groin and an umbilical hernia near the belly button. The underlying cause is a dual weakness in the fascia, the strong layer of connective tissue that makes up the abdominal wall. These weaknesses allow internal contents, such as fatty tissue or a part of the intestine, to protrude.
Symptoms and Recognizing the Problem
The primary symptom of a hernia is the appearance of a soft bulge or lump in the affected area, which may become more noticeable when standing, coughing, or straining. This is often accompanied by discomfort, a burning or aching sensation, or a feeling of pressure or heaviness in the groin or abdomen. With a double hernia, these symptoms can be present in two separate regions, though a patient may only notice the larger or more painful defect.
It is important to watch for symptoms that may signal strangulation, a serious complication occurring when the blood supply to the trapped tissue is cut off. Signs of a strangulated hernia include sudden, severe pain that intensifies rapidly, nausea, vomiting, fever, and a bulge that becomes firm, tender, or discolored. This condition requires immediate surgical intervention to prevent tissue death and potential life-threatening infections.
How Double Hernias Are Diagnosed and Repaired
Diagnosis of a double hernia begins with a thorough physical examination, where a doctor manually checks for bulges or tenderness, especially in the groin area. The patient may be asked to cough or strain to make the hernia more prominent. While a physical exam is often sufficient, imaging tests like an ultrasound or a CT scan may be used to confirm the diagnosis, map the two separate defects, and rule out other abdominal issues. Identifying both hernia sites is essential for planning a comprehensive repair.
The repair of a double hernia usually involves a single surgical procedure to address both defects simultaneously. Surgeons choose between two primary approaches: open repair or laparoscopic repair. Open surgery, or herniorrhaphy, involves making a larger incision over the hernia site, pushing the protruding tissue back into the abdomen, and then stitching or reinforcing the weakened muscle wall.
Laparoscopic repair, a minimally invasive technique, is often the preferred method for bilateral or double hernias. This technique uses small incisions through which a laparoscope and specialized surgical instruments are inserted to repair both defects from within the abdominal cavity. Both open and laparoscopic methods utilize surgical mesh, a flat sheet of synthetic material, to reinforce the weakened abdominal wall and reduce the risk of recurrence. The laparoscopic approach is advantageous for double hernias because it allows the surgeon to visualize and repair both sides without requiring two large, separate incisions.
Post-Surgical Recovery and Prognosis
Following a double hernia repair, most patients can expect mild to moderate pain and discomfort at the incision sites for several days. Pain management is important during the initial recovery phase. Patients are encouraged to use prescribed pain medication and to apply gentle pressure, or splint, the incision site when coughing or sneezing. Patients are typically discharged on the same day for laparoscopic procedures, while more complex open repairs may require an overnight stay.
A full recovery usually takes between four to six weeks, though this timeline can vary based on the patient’s overall health and the complexity of the repair. Light activities like walking are encouraged soon after surgery to promote blood flow and healing. Strenuous activities and lifting objects heavier than ten pounds must be avoided for at least four to six weeks. The prognosis for a double hernia repair is favorable, with modern mesh techniques lowering the chance of recurrence. The risk of recurrence is minimized by following all post-operative instructions and allowing adequate time for the reinforced tissue to heal.