Hernia

About Hernia

A hernia occurs when tissue protrudes through a weakened area in the abdominal wall.  The operation that repairs a hernia is  called a herniorrhaphy. This page will explain:

  • Why you may need to have your hernia repaired?
  • The ways that a hernia may be repaired
  • What to expect before and after the operation?

Though a hernia repair is a very common operation, no two people undergoing a hernia repair are alike. The reasons for and the eventual outcome of the operation depend upon your overall health, your age, the severity and size of your hernia, and the strength of your abdominal wall tissues.

A hernia develops when the layers of the abdominal wall weaken, bulge, or tear. The hole in this outer layer allows the inner lining of the abdominal cavity to protrude and form a sac. Any part of the abdominal wall can develop a hernia. The most common site is in the groin.  A hernia in this area is called an inguinal hernia. In an inguinal hernia,  the sac protrudes into the groin toward and sometimes into the scrotum. Although most common in men, inguinal hernias can also occur in women.

Another type of hernia occurs in the navel. It is called an umbilical hernia. A hernia that develops in a surgical incision is called an incisional hernia. A hernia elsewhere in the abdomen could be a ventral, epigastric, or spigelian hernia.

Who Gets Hernia?

Most inguinal hernias in adults result from strain on the abdominal muscles, which have  been weakened by age or by congenital factors. The types of activity associated with the appearance of an inguinal hernia include:

  • Lifting heavy objects
  • Sudden twists, pulls or muscle strain
  • Marked gains in weight, causing increase in abdominal wall pressure
  • Chronic constipation
  • Repeated attacks of coughing
  • Straining to urinate

A hernia is reducible if the protruding sac of tissue 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. In others, 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 tender lump that won’t go away indicates that the hernia has strangulated. When this occurs, the intestine can die quickly, leading to a life-threatening  emergency that requires immediate medical attention.

Preparing for an Operation

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, hernia repair is an elective operation. Most hernia repairs can be performed on an outpatient basis, although very large or extensive hernias may require hospital stay for several days.

Types of Procedures

There are a variety of procedures available to repair hernias. The right one for you will be determined by your specific situation.

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. This decreases postoperative pain, allows for quicker recovery and decreases the chance of recurrence. Mesh comes in a variety of shapes and sizes. Your surgeon will choose the best one for your particular hernia.

An inguinal hernia can be repaired through a small incision in the groin (open technique) or with a laparoscope. The advantage of the open technique is that it can be done under mild sedation and local anesthesia. Laparoscopy requires general anesthesia. The recovery from both operations is very similar. Generally, a laparoscopic technique is preferred for bilateral hernias (hernias in both groins) or recurrent hernias. Otherwise the open technique may be the best option for you.

An umbilical hernia may be repaired by suturing only if it is small. Larger umbilical hernias are repaired with mesh. This is generally done through a small incision in the  umbilicus.

An incisional hernia, a ventral hernia, or a very large umbilical hernia may be repaired with a laparoscopic technique. In this operation, a piece of mesh is placed over the  hernia on the inside of the abdominal wall and secured in place.

Complications

As with any surgery, there are risks and there can be complications. Complications are  not common but you should be aware of the possibility. Complications can include, but  are not limited to:

  • Infection
  • Bleeding
  • Hernia rcurrence (1-2%)
  • Injury to the testicle, cord or vas deferens
  • Other organ injury
  • Chronic pain
  • Numbness
  • Anesthetic complications
  • Complications related to the mesh
  • Adhesions or scar tissue formation
  • The need for further or repeat surgery

Recovery

After the operation, you will be taken to the recovery room where you will be watched carefully for about 1-2 hours until the anesthetic effects wears off. Post-operative pain is usually well controlled with oral medication. Some patients report  requiring no pain medicine at all. Occasionally, there will be some nausea until the anesthesia wears off. Your nurse can give you medication for this.

Most laparoscopic hernia patients go home the same day. After leaving the hospital, gradually return to normal activities over the next 3 to 5 days. In the first week after the surgery you may notice some bruising around the incisions. For inguinal hernia repair, you may have some swelling or bruising of the penis and scrotum. Mild abdominal distension is normal. You may shower the day following surgery.

You should see your surgeon for follow-up one or two weeks after surgery. 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 yourself too quickly. Constipation is also common after surgery, so begining a stool softener 2 days prior to surgery can be helpful.