Hernia Repair

A hernia can occur when the tough lining of the abdomen, known as the fascia, weakens and abdominal contents push through. Intestine/colon or fat tissue may then push through the hernia defect. Hernias can be very disruptive for some, while others will never know they have one. It is important to note that hernias are a progressive disorder, meaning they do not improve independently. While many hernia belts or other devices claim to improve hernias non-surgically, this has not been proven to work. Indeed, the only proven solution to a hernia is surgical repair.

One of the most-performed, minimally invasive surgical procedures in the United States is hernia repair. Approximately 1 million hernias are repaired annually, with about 75% of those inguinal or groin hernias. Inguinal hernias affect men far more than women. Other hernias include incisional (from surgery), umbilical (belly button), and femoral (thigh). The risk of serious complications varies depending on the location of the hernia. For example, inguinal hernias have about a 1 to 2% chance of serious complications, while femoral hernias may have up to a 20% chance.

The Symptoms of a Hernia

Hernias can be extremely painful. On the other hand, many patients will never know they have one. When a hernia becomes symptomatic and interferes with the patient’s lifestyle, it should be corrected soon to avoid additional complications. The pain associated with a hernia can start as mild but, if left untreated, can quickly escalate. This is especially true if the hernia contents become incarcerated; in other words, they cannot be pushed back into the abdomen. The worst-case scenario is strangulation, where the incarcerated hernia loses blood flow, and tissue begins to die. This emergency requires an immediate trip to the ER and is generally associated with less favorable surgical outcomes.

It is important to note that severe hernias may not present commensurate pain. For example, small hernias may be very painful, while larger hernias may only present with mild discomfort. As a result, it is essential to visit your primary care physician or general surgeon to get a proper diagnosis and understand more about the particulars of your hernia.

How is a Hernia Repair Performed?

Hernia repair is a straightforward procedure; however, allowing the hernia to grow makes surgery more complex. The patient may be more susceptible to complications and recurrence in these cases.

Specialized, robotically assisted miniature surgical devices are inserted into the stomach, including a high-definition camera known as a laparoscope. First, we will reduce the hernia by removing the abdominal contents from the defect. We will cover the defect using self-adhering surgical mesh without suturing it closed. This non-tension repair significantly reduces the risk of recurrence. Over the next few weeks, the body will grow scar tissue over the mesh, creating a solid barrier.

Most of our hernia repairs are performed with minimally invasive robotic surgical technology, reducing pain, blood loss, and recovery time. Certain patients will require an open hernia repair, which can be determined after a thorough evaluation and consultation with our office.

For the most part, repairs are performed in an outpatient surgery setting, but some cases will require an overnight stay. Much like any other surgical procedure, there are risks associated with a hernia repair, especially if the hernia is large or if we are dealing with a recurrence. Patients should discuss the benefits and risks of this surgery with our office.

What about chronic pain after inguinal hernia repair?

If you’ve researched inguinal hernias, you may have come across a common complaint about chronic pain. This issue has primarily been addressed with advancements in technique and technology. We pay special attention to the nerve bundles in the groin area during dissection, being sure to use blunt dissection rather than sharp cutting tools. Further, today’s hernia mesh is lighter and customized to the patient’s anatomy. Finally, the self-adhering mesh has eliminated the need for titanium or absorbable tacks, which in the past would have potentially injured or irritated nerves in the area. It is also important to note that the pain level before the hernia procedure often indicates how much pain a patient will feel afterward. Therefore we often suggest that patients proactively have their hernia repaired even if it is not causing significant pain.

Is Surgery Always Necessary?

Typically, if a hernia is found incidentally and is not symptomatic, we do not suggest that it be repaired. For symptomatic hernias, younger patients are ideal candidates for surgery, as their surgical risk is relatively low, and their chance of complications, including strangulation, is significantly higher than older patients. However, patients of advanced age may have more leeway in determining whether they wish to proceed with a hernia repair. The weakened musculature of the abdomen due to their age means that strangulation is less likely. However, this same characteristic may also allow the hernia defect to grow faster.

During your consultation with us, you will discuss the pros and cons of having hernia surgery and decide accordingly.