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What is a hernia?
A hernia occurs when there is a weakening in the abdominal wall. This weakening of the natural support allows abdominal contents (bowel) to slide into the hole (refered to as the "defect"). If part of the bowel slides through and gets caught (incarcerated), it can be painful and dangerous since the blood supply can be jeopordized. You may feel or see a pouching out (lump or swelling) of the belly or groin area, or you may feel and see nothing at all. Hernias are more noticeable when standing, coughing and straining, and may disappear when lying down. They sometimes can be pushed in with the finger; but all should be examined by a physician.
Where do you get hernias?
The groin area is the most common site of a hernia (80%); hernias in this area are called inguinal hernias. But hernias can occur below the groin area (femoral), at the belly button (umbilical), in the abdominal area and at sites of prior surgery (incisional).
Why do people get hernias?
Men, women, and children of any age can get hernias. They can occur because you were born with a natural weakness in the abdominal wall, or from a weakness acquired with age. Contributing factors include previous surgery in the abdominal area, excessive weight gain, pregnancy, constipation, infection, malignancy, or trauma. Strenuous physical activity including heavy lifting may also be a contributing factor.
How are hernias treated?
Hernias don't go away. All defects, even ones that show no symptoms ("asymptomatic"), should be surgically corrected since the risks of surgery are much less than the risks to you of not fixing the hernia. Once you develop symptoms, surgical repair is mandatory. Small asymptomatic hernias can sometimes be pushed back into place by your doctor, but surgery is the only way to really fix a hernia.
Surgical repair of hernias
There are two main ways to surgically fix a hernia: open repair and minimally invasive laparoscopic repair.
Open Surgical Repair of Hernia
This type of repair involves making a cut (incision) over the hernia, carefully dissecting through the body tissues and closing the area of weakness. Usually a mesh (composed of gortex, teflon or other material) is sewn into place over or under the weakened area to make it stronger and to prevent recurrence. After the repair, the incision is closed and covered with a bandages and tape.
Local anesthesia(lidocaine, mepivacaine) is commonly used to prevent you from feeling pain during the procedure. In addition, the anesthesiologist gives a mixture of short-acting sedating medications to provide comfort. Occasionally spinal or general anesthesia may be required for larger hernias or more complicated cases. Postoperative pain may be managed with a combination of intravenous, intramuscular and oral painkillers. You may have some trouble urinating for the first 12-24 hours following the procedure.
The main disadvantage of the open technique is that it can cause considerable pain. You may not be able to return to work for a week or longer and full activity may not be possible for up to six weeks. Swelling and black and blue discoloration of the wound site is common. Repairs of repeat inguinal hernias, and two sided repairs, are much more painful and have a much longer recovery period.
Laparoscopic Hernia Repair
A small incision at the area of the belly button (umbilicus) is made through which a telescopic device called the laparoscope is inserted. Your surgeon looks through the laparoscope and at a magnified image projected onto a video monitor. A balloon device is used to carefully open up the area to be repaired, and the area is inflated with carbon dioxide so that the surgery can be safely performed. Your surgeon passes instruments through small incisions (one-fourth to one-half inch) to dissect body tissues and to repair the hernia. A mesh to strengthen the weakness is fixed into place with titanium staples to strengthen the area and prevent recurrence of the hernia. After the repair, local anesthesia is given at the incision sites to minimize pain and all of the small incisions are closed and covered with steri-strips or Band-Aids.
General anesthesia is commonly used to provide optimal operating conditions for the procedure and a pain-free state. Local anesthesia is added in the areas of the incisions to provide pain relief after the surgery. Any additional postoperative pain can be alleviated with small doses of intravenous, intramuscular or oral painkillers. Side effects from the anesthesia and surgery can include sleepiness, nausea or vomiting. Medication can be given to treat all of these conditions. As with the open method, urinating may be affected. You should be able to go home a few hours after your surgery is finished.
The main advantage of the laparoscopic technique is that it avoids painful incisions. Pain and discomfort are dramatically less than with the open technique. A secondary advantage is that both sides can be examined during a single surgery. Most patients are able to return to work within 72 hours and resume full or nearly full physical activity by one week.
What should I expect after surgery?
You will need an escort to take you home after the surgery because you may still feel sleepy after the anesthetic. It is also a good idea to have someone with you for 12 to 24 hours to make sure that you can eat and drink normally.
Side effects from the anesthesia and surgery include pain, muscle aches, abdominal swelled, stomach queasiness, nausea and/or vomiting, headache, somnolence or sleepiness, and sore throat (from the breathing tube). Mild pain and anti-nausea medications are given to all patients to help minimize this tendency and minor discomforts. All of these side effects will dissipate over the next few days.
Most patients need a few days to recover and get their strength back. Full activity in both open and laparoscopic procedures is encouraged after 48 hours, though the amount any patient can do is dependent on the type of procedure performed and individual responses to pain.
You will need to make an appointment with your surgeon for 1 week after the surgery to follow-up and check on your healing.
