What Is A Hernia?
A hernia is a weak place usually in the abdominal wall or groin area that allows an internal body part or organ to push or bulge through. It can occur gradually due to normal wear and tear, called an acquired hernia, or be a weakness present from birth called a congenital hernia. Hernias can also occur at sites of previous surgery or injury due to weakened tissues.
What Kind of Symptoms Are Caused by Hernias?
Hernias may often present as a bulge or lump in the abdominal wall or in the groin. Usually the bulge is spontaneously reducible or can be made to disappear in the lying down position or by gentle manipulation. If the hernia is not reducible then it is designated “incarcerated” and is potentially more dangerous because bowel or other delicate internal organs may be entrapped. Rarely bowel can become so tightly pinched or strangulated that it loses it blood supply and will die if surgery is not performed immediately.
Most hernias do not cause significant pain unless they become incarcerated, but patients may feel vague discomfort or sharp pain related to activities like bending over coughing or lifting. These symptoms may be more prominent at the end of the day. Sometimes related medical problems such as chronic constipation, enlarged prostate glands and chronic lung disease can aggravate hernia symptoms and cause enlargement because of the repeated straining associated with these medical conditions. Some of the locations where hernias can occur on the abdominal wall include the following:
- Inguinal – this is the groin area, either right or left-sided.
- Femoral – this is the lowest part of the groin area in the crease between the thigh and the abdomen.
- Umbilical – this is the belly button area.
- Incisional – any where an incision has been made in the abdominal wall or the flank area.
- Spigelian – these rare hernias occur in the right or left lower abdominal wall at the lateral edge of the rectus (6-pack) muscles.
- Epigastric – these hernias occur anywhere from the breast bone to the belly button in the midline and are due to a congenital weakness in this area.
Hernia Treatment and Hernia Surgery
If a hernia is very small and causing no symptoms it may not need to be treated or can be followed without surgery. Indications for treatment are enlargement, local pain or incarceration (the bulge cannot be reduced). If the hernia becomes suddenly tender and firm and cannot be reduced then it may need to be repaired emergently.
Hernias can be repaired either by an “open” technique or by “laparoscopic” technique. The open technique means making an incision over the hernia bulge through the skin down to the weak area in the abdominal wall tissues. This area is repaired with sutures and reinforced with a mesh patch. Mesh can be made of a variety of permanent (polypropylene, Gortex) or biodegradable materials. The surgeon chooses the type depending on the size, location and degree of contamination of the hernia repair site. The open technique can be done under general anesthesia, spinal or even local with IV sedation.
Laparoscopic technique means a minimally invasive technique which usually approaches the weak area through three separate small incisions. The hernia is reduced and the mesh is applied from the inside of the abdominal cavity covering the defect or weak area. This approach is usually less painful and allows a little quicker resumption of normal activities with a recurrence rate that is just as low as the open technique. This technique requires general anesthesia.
Depending on the size and location of the hernia mesh can be placed on top of the abdominal wall tissues, between some of its layers, or on the inside.
- Symptoms – pain or discomfort may lead the patient to his or her physician. A bulge, bump or lump on the abdominal wall may be seen by the patient.
- Physical exam – the patient or the physician may feel and see the hernia or bulge on exam.
- X-rays – a CAT scan or ultrasound may demonstrate or confirm the weakness and protruding hernia.
- A good history and physical is routinely done to discover other medical problems which might affect the treatment method such as heart, lung or kidney disease.
- Routine labs are performed as well as an EKG in any patient who is over age 40 or has a history of heart disease.
- All blood thinners such as aspirin, Coumadin should be stopped at the appropriate time interval prior to surgery.
- The patient should shower thoroughly and wash the abdominal wall including the umbilicus. This can be done the night before or early a.m. of surgery.
- Antibiotics are given intravenously preoperatively to prevent infection.
- The patient should not take anything by mouth after midnight the night before surgery.
- Selected medicines may be given early the morning of surgery with a sip of water. The individual patient should consult his or her physician.
Postoperative Care following Hernia Surgery
- Often these surgeries are outpatient and the patient will be able to go home the same day.
- Immediately after surgery the patient will go to the recovery room until the anesthetic effects are worn off. The patient will receive intravenous pain and nausea medicine in the recovery room as needed.
- The patient will then be transferred to a regular bed in an outpatient or inpatient unit after about an hour in recovery. If other medical conditions allow the patient may be discharged when eating without nausea, ambulating, voiding (emptying the bladder), and when pain is controlled by oral medications.
- If sutures or drains are present at discharge then the patient will usually return in about a week for removal. Antibiotics and pain medicines will be prescribed and usually home medicines continued as before. Instructions regarding activities allowed will be individualized, but most hernia repairs allow resumption of normal activities like driving within a week.