Hernia Repair

When a Hernia Happens

Men, women and children of all ages can have hernias. A hernia is a weakness or tear in the wall of the abdomen. It is sometimes called a "rupture".

How Hernias Form

Acquired hernias are caused by wear and tear over the years. Congenital hernias result from a weakness in the abdominal wall that is present at birth. Hernias may get worse, or grow larger with time or physical stress.

Just as a bulge can form in a worn tire, a hernia may form in a weak abdominal wall. At this weak spot a hernia sac forms, this may fill with intestine or fat. When this happens, it often causes some pain. Hernias can occur around your navel, groin, or an old abdominal incision. Prompt surgery is often advised because hernias won't go away by themselves. If the intestine becomes trapped in the hernia, serious intestinal and digestive problems can occur.

Where Hernia Might Occur

An Incisional Hernia occurs at the site of a previous surgical incision, anywhere on the abdomen.

An Umbilical Hernia occurs in the umbilical ring around the navel.

An Inguinal Groin Hernia occurs in the groin near the internal ring. There are 2 types of inguinal hernias. A direct hernia occurs when the intestines passes through the muscle layers of the abdominal wall into the groin. An indirect hernia occurs when the intestine passes through the groin and descends into the scrotum.

A Recurrent Hernia occurs at a previous hernia site. It can often be repaired using laparoscopy.

When You Notice a Bulge

It's often easy to tell if you have a hernia. You may notice a bulge under your skin. You may also feel pain when you lift, cough or strain during urination or bowel movements. The pain may be sharp, sudden or both. In some cases, it may be a dull ache. The pain may get worse near the end of the day or after you stand for a long time.

The Wall Weakens or Tears

The abdominal wall may weaken or tear. A loop of intestine or fatty tissue may then push against the peritoneum. This forms a sac. You're not in immediate danger at this point. You may not even be able to see a bulge. But you may feel burning or tingling.

The Intestine Pushes into the Sac

As intestine pushes into the sac, a bulge may be seen externally. Sometimes the bulge flattens out when you lie down or push against it; this means you have a reducible hernia. Although you're not in immediate danger, you still need hernia repair.

The Intestine May Become Trapped

If intestine becomes incarcerated (trapped), you won't be able to flatten the bulge. This is a non-reducible hernia, and is often painful. Prompt surgery is required.

The Intestine May Become Strangulated

If intestine is strangulated (tightly trapped), it loses its blood supply and dies. A strangulated loop of intestine can also block digestion. It can cause severe pain. Emergency surgery is required to relieve the blockage and repair the hernia.

Surgical procedures are done in one of two fashions.


I. The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done using monitored anesthesia,  general anesthetic or I.V. sedation..

II. Laparoscopic Repair Your doctor may recommend laparoscopic surgery to repair your hernia. Laparoscopic surgery is done with a laparoscope, a tiny "telescope", attached to a camera. It allows your surgeon a close-up view of your hernia using only a small incision. The surgery usually takes 1 to 2 hours and you can likely go home the same day. Because large incisions are not required, recovery from laparoscopic surgery is often faster and less painful than after open surgery. You will also only have a few tiny scars instead of a single long one. Laparoscopy has been used with success for years in many types of surgery, including hernia repair. Your doctor will decide which type is best for you, depending on the kind of hernia you have.

Risks and Complications

Bleeding, infection, numbness or pain in the groin or leg, urinary retention, bowel or bladder injury, recurrent hernias, deterioration of testes and risks of anesthesia.

During the Procedure

You'll be given general or regional anesthesia. This keeps you free from pain during surgery. Depending on the type of surgery you have, the number of incisions and their placement will vary. The laparoscope and other instruments are inserted through the incisions. Carbon dioxide gas is injected into your abdomen through an incision near your navel. The gas inflates your abdomen, allowing your surgeon to work. Then, the laparoscope is inserted through the same incision. Its tiny video camera sends clear images to a video monitor. A light beam shines inside your abdomen, allowing your surgeon to see the hernia. Small cutting and stapling tools are inserted through other incisions in your abdomen.

Patching the Weak Spot With A Mesh If Needed

After the hernia is repaired, your surgeon places strong mesh directly over the weak spot in your abdominal wall. The mesh acts just as a patch would on a tire wall. The mesh is secured with surgical staples, tacks, clips or sutures. These stay in place permanently; neither the mesh nor the staples are harmful to your body. Other reinforcement methods besides mesh may be used. After the mesh is applied, gas is released from you abdomen.

Lifting

During the week after surgery, lift only light objects that are easy to manage. Keep your back straight. Allow your legs to do most of the lifting. No lifting grader then 10 -15 pounds after open procedure.

Sex

You'll be able to have sex as soon as it feels comfortable.

Medications

Your incision may be tender at first. Your doctor may give you pain medication to use at home.

Driving

Don't drive for 1-2 days after surgery or while using pain medication.

Exercise

Light exercise can improve circulation. So, walk as much as is comfortable. It's also okay to climb stairs. Just take them slowly and one at a time.

Diet

At home, start eating a healthy, high fiber diet and drinking lots of fluids. Ask your doctor about using a laxative or stool softener if needed.

Work

You may be able to return to work within a few days for office jobs and within 2 weeks for more physical jobs. Talk to your doctor about when you can go back to work. 4 to 6 weeks for an open hernia with physical labor.

Follow-up Visits

Your doctor may schedule you for a follow-up visit in about a week. During the visit, your doctor will check how well you're healing. Your stitches or staples may be removed or bandages replaced. More visits may be scheduled.

Before and After Surgery

Schedule Lab Tests -such as blood tests, ECG, and chest x-ray.
You may be told to stop taking some medications, such as aspirin, ibuprofen or herbal remedies.

Quit smoking to avoid straining your hernia from "smokers' cough", and to promote good blood flow for healing.

Avoid putting strain on your hernia. No heavy lifting before or after surgery.
Don't eat or drink anything (not even water), after midnight the night before the surgery.

Plan to have someone drive you home after the surgery. Take it easy; you may need some extra help at home.

Recovery

After surgery, you may be given some medication to relieve discomfort. You'll have small bandages over your incision. You may also have an IV tube in your arm to give you fluids for the first few hours after surgery. In most cases, you'll be able to go home as soon as you're able to eat, drink, urinate and walk. Ask your doctor about how to limit your activity while you heal.

Once You're Back at Home

After surgery, you may notice swelling, bruising or soreness near your incisions. You may feel bloated, constipated or more tired than usual. These effects go away with time.

To ensure a smooth recovery, follow these guidelines.

Bathing

Ask your doctor how soon you can shower, bathe, or wash the area around your surgical site.

When to Call Your Doctor

Call your doctor if you have any of these problems:
Fever
Excessive swelling or bruising
Urinary retention
Redness
Bleeding
Increasing abdominal pain
Nausea or vomiting

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