A hernia is an abnormal
weakness, usually in the abdominal wall. When this occurs there is a bulge you
can see and feel, which contains organ or tissue. The most common hernias develop
in the groin, around the navel, or in an incision from a previous surgery. They
can be present from birth, develop slowly over years, or develop suddenly.
A hernia can be reducible (pressing on it causes it to disappear, and effort causes
it to be seen and felt), or non-reducible. There is a danger that a hernia can
strangulate (pinch off a portion of the bowel). This is a serious and very painful
situation, and must be operated on right away.
What
does a hernia feel like?
It may look like a lump
in your abdomen or groin. It may go away when you lie down, or it may not. You
may have a dull aching sensation in that area, and this may be more noticeable
when you strain your abdominal muscles, for example, when you cough or lift something.
It can become painful because of the pressure of tissue, which is pushing its
way through the weak area.
If you have already been diagnosed with a hernia and develop sudden severe
pain, you should call your physician right away to be sure that an urgent situation
has not developed.
Why
does a hernia develop?
A hernia can develop where
there is a weak area in the body. It can develop when there is an unusual strain
in that area, or because you are born with a weak area, or due to no apparent
cause. Some of the common areas that hernias develop are:
Umbilical hernia: Around the umbilicus (belly button), where
there is a natural weakness of the abdominal wall.
Inguinal hernia: Around the groin. This is most common in
men due to the unsupported space in the groin that develops when the testicles
descend into the scrotum.
Femoral hernia: At the top of the thigh. This is most common
in women as a result of pregnancy and childbirth.
Incisional or ventral hernia: In the abdominal wall, frequently
in an incision from previous surgery.
Hiatal hernia: A weakness at the top of the stomach that
can cause stomach contents to flow back into the esophagus (GERD, gastrointestinal
reflux disease, or heartburn).
Do
all hernias require surgery?
If a hernia is not surgically
repaired, it will not get better on its own, although it may not get worse for
months or even years. Techniques such as limiting activity, reducing weight, avoiding
heavy lifting, and wearing a truss or binder have been known to provide temporary
relief. However, you can only cure a hernia with surgery. Pain and to prevent
strangulation are two reasons that would indicate a need for surgery. If the hernia is reducible (can easily be pushed back into the abdomen)
it is not usually an immediate danger, and you would decide on surgery based on
your surgeon’s advice and how much pain you are having. However, if the hernia is non-reducible, it can become a life-threatening
situation, as part of the intestine gets trapped in the hernia. This is called
an “incarcerated” or “strangulated” hernia, and this requires
immediate surgery.
You should trust your surgeon’s advice when deciding whether nor not to
have surgery to repair your hernia. Although any surgery has risks and side effects,
today’s surgical treatment options for hernia repairs are vastly improved,
with minimal discomfort, quicker recovery, and better long-term effect.
What
are the surgical options for hernia repair?
Conventional method: This type of hernia repair is accomplished by making an incision over
the hernia. The surgeon then returns the tissue to its normal place in the abdomen,
and the hernia sac is removed. The resulting hole (weakness) in the abdominal
wall is then repaired by the surgeon, by sewing together the layers of muscle
and tissue in the abdominal wall. There is no mesh, or implant, that is used in
this repair. This can often be done under local anesthesia. Depending on activity
level, normal recovery for a hernia due to stress or strain that is repaired by
the conventional method is 4-6 weeks. The recurrence rate (reappearance of the
hernia) can be up to 10-15% with this method. Laparoscopic method: Tiny openings are made into the abdomen, and an instrument called a
laparoscope is inserted, through which the surgeon can view the hernia on a TV
monitor and reduce the tissue. Usually a patch of “mesh” is used to
reinforce the abdominal wall, which is fastened in place with staples. General
anesthesia is required. This method usually results in less discomfort and shorter
postoperative recovery time. Return to normal activities usually occurs in 7-14
days.
Tension-free mesh technique: The surgeon makes an incision at the site of the hernia and inserts
a piece of mesh to cover the abdominal wall defect. This procedure is usually
done under local anesthetic. The muscles are not sewn together as they would be
in a conventional repair, but instead the repair is “tension-free”.
This allows patients to get back to normal activities more quickly, and reduces
the incidence that the hernia may reappear to less than 2%. Return to normal activities
usually occurs in 2-3 weeks. Mesh plug technique: This procedure allows the patient to be operated on as an outpatient
under local anesthetic. The surgeon makes a small incision and inserts a mesh
plug into the hernia defect. This fills the hole, similar to a cork in a bottle.
Another piece of flat mesh is then placed over the plug to help prevent future
hernias in that area. As the body heals after surgery, tissue grows around and
through the mesh, making a stronger, more permanent repair. There is a shortened
recovery time and less than 1% recurrence rate. Typically the procedure takes
less than an hour to complete, and the patient can go home in less than 1 hour.
Return to normal activities usually occurs in less than 3 days.
How
soon can I return to normal activities?
Return to normal activities
ranges depending on the surgical technique chosen. With the mesh plug technique
patients are advised to progress at their own pace, and to return to normal activities
as soon as they wish. In most cases this has been 3 days of less.
As with any surgery, various surgical techniques are required for each patient,
and you must be evaluated for a recommendation on which technique is right for
your circumstances. Your surgeon will advise you on the best procedure for you.
Where
can I have this surgery done?
Keith
W. Millikan, M.D. has been a leader in the development of new surgical techniques
for hernias. His courses and lectures throughout the United States, Canada and
Japan are responsible for the training of many surgeons in the most recent techniques.
