Hernia repairs are our most frequent procedure.
We have extensive experience in the repair of every kind and variety of hernia. We are currently seeking designation as a Regional Hernia, Abdominal Wall Reconstruction Site of Excellence.
What is a Hernia?
A hernia is a tear in the lining of your abdominal wall. It is actually a hole, that allows tissues inside the abdomen to protrude. This often causes pain and buldging, and can be very uncomfortable. This can happen in any part of the abdomen.
Why Did You get a Hernia?
Hernias happen in all ages and in both men and women. Adult hernias usually are the result of strain on the abdominal wall. Factors that contribute to this include aging, genetic predisposition, heavy lifting, pregnancy, athletic activities, obesity, previous surgery, constipation, and chronic coughing.
Hernias are most commonly found in the groin. These are called inguinal hernias. There is a natural weak area in the groin, related to descent of the testicles in men. Women can have a similar problem, although they develop hernias less frequently. There are several variations of ingunial hernias such as femoral hernias, direct hernias and indirect hernias. They are all repaired in the same way, most commonly with a laparoscopic hernia repair. Mesh is placed over the area of the defect, in much the same way that a patch is placed inside a car tire. This reinforces the groin,and seals any hernia defects. We usually allow return to normal activity within 2 weeks after surgery. Please see the video at the bottom of this page.
Athletes and people who perform heavy labor occasionally develop tears in the tissues of the groin that cause significant pain, although often without bulging, these are called sports hernias. Sports hernias can often be difficult to diagnose. Patients, especially atheletes, have often been treated with physical therapy and a variety of other modalities by the time we see them. These hernias almost always recover quickly with proper surgical repair. All of these groin hernias are treated in the same way, with a laparoscopic hernia repair. Mesh is laparoscopically placed over the area of the defect. This reinforces the groin, binds the tissues together and seals any hernia defects. We usually allow return to normal activity within 2 weeks after surgery.
Hernias occur commonly in many parts of the abdomenal wall. They are all grouped together as ventral hernias. In the navel, these are called umbilical hernias. A hernia that forms in a old surgical wound is called an incisional hernia. There are a wide variety of other named hernias, depending on their position and anatomy. Examples are lumbar hernias, obturator hernias and several others. Almost all of these hernias are able to be repaired with laparoscopic surgery, however some are better treated with an open procedure. We have extensive experience in repairing all of these defects. Please see the video at the bottom of this page.
Some ventral and incisional hernias can become extremely large. They can develop a variety of secondary complications, including fistulas, bowel obstruction, exposed mesh and other problems. The larger hernias often require a more extensive repair, such as component separation or abdominal wall reconstruction. These procedures may require open techniques and even prolonged hospitalization. Newer techniques have allowed us to repair, previously unrepairable defects. We have had a great deal of experience in treating these challenging problems, and have had very good success.
Should You Have Surgery?
Hernias usually are repaired electively at your convenience. Important points to consider in deciding whether or not to proceed with surgery are:
- The hernia will never improve or heal by itself.
- The hernia and the symptoms of pain will only get worse with time.
- As long as you have a hernia, there is a risk of strangulation that may require emergency care. A strangulation is a condition where a piece of intestine can become trapped in the hernia. This causes extreme pain and the bowel can be seriously injured.
The greatest risk of undergoing hernia repair is that the hernia can come back. Fortunately, with modern surgical techniques the chance of recurrence is very low.
Hernia surgery can almost always be done as an outpatient procedure. Activities and restrictions after surgery vary. Most patients are restricted to a lifting limit of 15 pounds and to limited physical activity. These limits can vary from 1 to 2 weeks for laparoscopic inguinal surgery, to 6 to 8 weeks for ventral and incisional hernias. Patients recovering from very large ventral or incisional hernias may need to make a permanent life-style change and always avoid lifting and straining to reduce the chance of recurrence. The specific limits for your surgery will be discussed with you by your surgeon. Please call or ask if you are not sure of your limits.
Some patients with large or recurrring ventral hernis (especially those with jobs that require heavy lifting) may want to consider using an abdominal support or weight lifter's belt. This link has more information. Abdominal Binder/Support Belt
Types of Procedures
This is the most common type of repair that we perform. A variation of laparoscopic repair is used for inguinal hernias, sports hernias, and most ventral hernias. The laparoscope is a thin camera which allows surgery inside of the abdomen, and in the internal spaces of the groin. The scope is inserted into the abdomen through a small incision. The surgeon is then able to view interior anatomy on high definition video monitors. Additional incisions are made for instruments needed to repair the hernia. A patch of mesh material is then placed over the hernia and sutured or stapled into position. This repair is very similar to the patch repair used to fix a flat car tire, with the patch placed on the inside of the tire. Occasionally, internal relaxing icisions are made, to allow larger ventral hernias to be closed. The latest trend in ventral hernia repair is to place mesh within the layers of the abdominal wall and to not place mesh in the abdominal cavity. The most common procedure using this technique is called an eTEP (extended totally extra peritoneal). The diagram on the right shows the retromuscular space where we prefer to place mesh for ventral hernia repair.
Abdominal Wall Reconstruction / Component Separation Repair
These open procedures are used for complicated ventral or incisional hernias. An incision is made over the site of the hernia, and the protruding tissues are returned to the abdominal cavity. Old mesh is removed and fistulas and bowel problems are repaired during the surgery. Internal relaxing incisions are made in the sides of the abdominal wall which allows the hernia to be pulled closed. A piece of biologic or synthetic mesh is inserted to cover and reinforce the area of the hernia, and is sewn into the abdominal wall. This technique is often used for hernias from old incisions in the abdominal wall, and to repair recurrent and very large defects. These are major operations, that often require several days of recovery in the hospital. It is very common for the anesthesiologist to place an epidural catheter in your back for post operative pain control. Plastic drains are often placed, and may be present for over a week.
The latest innovation in hernia surgery is the use of the surgical robot. We are now able to offer Robotic Surgery for a variety of hernia problems. The robot can increase our precision, and new developments continue to improve the lives of our patients. The robot may be offered for selected patients and conditions. Please feel free to discuss this with your surgeon.
These animations demonstrate laparoscopic hernia repair:
Mesh is commonly used to reinforce and fill the gaps left by hernias. Mesh is made from a variety of synthetic and biologic materials. New mesh products are entering the surgical world every year. Many of the mesh products look like plastic window screen. All of these products are well accepted by the body. They cannot be rejected or even be identified by your body's immune system. They provide a strong, safe repair that reinforces your own tissue, and reduces the chance of recurrence. We only use mesh that has proven to be safe and reliable.
The type of hernia repair, and the type of mesh that may be needed are selected for your specific needs. We will be happy to discuss the merits of various marerials if you are interested..
Symptoms of Hernias
Bulges that can be seen or felt in the scrotum, groin or abdominal wall.
- A sensation of pressure or pain.
- A burning feeling that may be associated with a bulge.
- A hernia is reducible if the bulging tissue can be pushed back into the abdomen. If the hernia cannot be pushed back it is called incarcerated.
Occasionally an incarcerated hernia will get so tight that its blood supply is cut off and the tissue can begin to die. The symptoms of this problem include; rapidly worsening pain, a very tender bulge, and even nausea and vomiting.
This is called a strangulated hernia, and is a true emergency. When strangulation occurs, the tissue can rapidly die and become infected. Within hours this can lead to a life threatening problem that requires immediate surgery.
Please contact us immediately or go to the nearest emergency room if you think you have a strangulated hernia.