Although there are many types of hernias, they typically present as a hole in the abdominal muscular wall through which abdominal contents protrude. An operation to repair a hernia is called a herniorrhaphy.
Though a hernia repair is a very common operation, no two people undergoing a hernia repair are alike. The reasons for and the outcome of the operation depend on the patient’s overall health, age, the severity and size of the hernia, and the strength of the abdominal wall.
A hernia develops when the layers of the abdominal wall weaken, bulge, or tear. Although any part of the abdominal wall can develop a hernia, the most common site is the groin, referred to as an inguinal hernia. Inguinal hernias can occur in women but males are naturally more prone to inguinal hernias from the descent of the testicles through the abdominal wall prior to birth.
Another type of hernia, an umbilical hernia, occurs in the navel (or umbilicus). A hernia that develops in a surgical incision is called an incisional hernia. A hernia elsewhere in the abdomen could be a femoral, ventral, epigastric, hiatal, or Spigelian hernia.
Most inguinal hernias in adults result from strain on abdominal muscles weakened by age or by congenital factors. The activities associated with an inguinal hernia include:
- Lifting heavy objects
- Sudden twists, pulls, or muscle strain
- Marked gains in weight, causing an increase in abdominal wall tension
- Chronic constipation
- Repeated attacks of coughing
- Straining to urinate
A hernia is reducible if the contents can be pushed back into the abdomen. If the hernia cannot be pushed back in, it is incarcerated.
The symptoms of hernias vary. Sometimes the onset is gradual, with no symptoms other than the development of a bulge. Other times the hernia may present with a sudden giving away of the abdominal wall, which may be accompanied by pain.
In some cases, an incarcerated hernia gets so constricted that the blood supply is cut off and the tissue swells. Increasing pain or a persistent tender lump indicates a strangulated hernia. When this occurs, the intestine can die quickly, leading to a life-threatening surgical emergency.
Surgery is the only way to repair a hernia, they do not heal spontaneously and generally increase in size over time. Unless the hernia is strangulated, a hernia repair is an elective operation. Most can be performed on an outpatient basis, although very large or extensive hernias may require a multiple day hospital stay.
Modifiable risk factors for hernia repair should be addressed prior to surgery. The most impactful are obesity, diabetes and smoking. It may be suggested or required for a patient to lose weight, stop smoking or have your blood sugars under control prior to undergoing hernia surgery. Addressing a chronic cough or straining with urination may be helpful preoperatively as well.
In general, hernias can be repaired open, laparoscopically or robotically. Open repair involves a traditional incision about the size of the hernia opening. Laparoscopic and robotic hernia surgery are performed through multiple one-quarter to half-inch incisions. Choosing the right technique for a hernia repair is a complex decision made by the surgeon while considering the patient’s preference, health, and the complexity of the hernia. Click here to learn more about laparoscopic and robotic surgery.
Most hernias are repaired by using a mesh material to reinforce the tissue in the affected area. This mesh allows for a “tension-free” repair. The body’s incorporation of the mesh provides added strength to the abdominal wall and decreases the chance of recurrence. Mesh comes in a variety of materials, shapes and sizes, the surgeon determines the best option for each particular hernia.
If a hernia is repaired and comes back, it is called a recurrence. Recurrent hernias can be more complex to fix and chances of success diminish with each repair.
As with any surgery, there are risks. Complications are not common but may include:
- Hernia recurrence
- Injury to the testicle, cord or vas deferens
- Other organ injury
- Chronic pain
- Anesthetic complications
- Mesh related complication
- Adhesions or scar tissue formation
- The need for further or repeat surgery
After the operation, the patient is carefully observed in the recovery room for about 1-2 hours until the anesthetic effects wear off. Post-operative pain is usually well controlled with oral medication and some patients require no pain medicine at all. Occasionally, there will be some nausea until the anesthesia wears off which is treated with medication.
Most hernia patients go home the same day as their surgery. After leaving the hospital, patients should gradually return to normal activities over the next 3-5 days. In the first week after the surgery there may be some bruising around the incisions. For inguinal hernia repair, there may be swelling or bruising of the penis and scrotum. Mild abdominal distension is normal. Patients may shower the day following surgery.
Patients should follow-up with their surgeon one or two weeks after surgery and avoid strenuous activity for two weeks. Recovery varies depending on the type and extent of the hernia, the individual patient, and the type of repair. It is important not to over exert too quickly. Constipation is also common after surgery, so beginning a stool softener 2 days prior to surgery can be helpful. A laxative may be needed, especially if taking opiate pain medication.