Hernia Surgery

What is a hernia?

A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon - like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing pain and other potentially serious health problems. Men and women of all ages can have hernias. Hernias usually occur either because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall, such as the strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. Eighty percent of all hernias are located near the groin. Hernias may also occur below the groin (femoral), through the navel (umbilical), and along a previous incision (incisional or ventral).

What are the Symptoms of Hernias?

• A noticeable protrusion in the groin area or in the abdomen
• Feeling pain while lifting
• A dull aching sensation
• A vague feeling of fullness

If you develop a painful bulge in the abdominal wall or groin that won't go away when you lie down and that is accompanied by generalized abdominal pain, nausea, bloating, you should get in to see your family physician or emergency room right away. These are symptoms of intestine trapped in the hernia that can possibly lead to gangrene.

How are hernias repaired?

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is usually performed on an outpatient basis (which means the patient can go home the same day of the procedure). This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally invasive). Your surgeon will determine the best method of repair for your individual situation.

Open Repair Surgery

• An anesthesiologist (a physician who specializes in pain relief) will recommend a type of anesthesia according to your condition and health status. You will not feel pain during the surgery.
• A small incision or cut is made in the skin.
• The hernia "sac" containing the bulging intestine is identified.
• The surgeon pushes the intestine inside the hernia sac back into its proper position behind the muscle wall.
• The muscle wall is reinforced with stitches or usually synthetic mesh to complete the repair.

Most patients will be able to go home a few hours after surgery. If needed, a 23 - hour extended recovery area is available. Typically, most patients feel fine within a few days after the surgery and resume normal eating habits and activities. Strenuous activity and exercise are restricted for 4 to 6 weeks after surgery.

Laparoscopic Surgery

Laparoscopic surgery uses a thin, telescope - like instrument (known as an endoscope) that is inserted through a small incision at the umbilicus (belly button). Usually, this procedure is performed under general anesthesia. This requires an evaluation of your general state of health, including a history and physical exam, possibly including lab work and EKG. The endoscope is connected to a tiny video camera - smaller than a dime - that projects an "inside view" of the patient's body onto television screens in the operating room. The abdomen is inflated with a harmless gas (carbon dioxide) to allow your surgeon to view your internal structures.

The defect in the abdominal wall or in the groin is visualized and covered with a synthetic patch that is then secured into position with sutures or tacks.

Benefits of laparoscopic hernia surgery

• Very small scars rather than one larger incision
• Reduced postoperative pain
• Faster return to work
• Shorter recovery time and earlier resumption of daily activities (a recovery time of days instead of weeks)

When to seek Medical Advice

If you think you have a hernia, you should see your family physician. They will examine you and if you do in fact have a hernia you should consult with a surgeon. The surgeon will be best able to advise you on what type of repair is best for your situation. Rarely, hernias can be observed over time without being repaired. This is usually in cases where the risks of an operation are just too high.

Do It Yourself

Some people will try trusses (hernia belts) to treat their hernias themselves. These devices may help to temporarily relieve symptoms, but they do not take care of the underlying problem. Hernias never heal without surgery. Trusses worn over long periods of time can cause scarring inside the hernia sac and make repair that much more difficult or dangerous. For more information on hernias please see the National Institutes of Health website.