What is a Hernia?

A hernia occurs when the inner layers of the abdominal wall weaken the bulge or tears. The inner lining of the abdomen pushes through the weakened area to form a sac. Whatever is near the hernia, usually fatty tissue or intestine, can push into the sac causing discomfort and other potentially serious complications.

A hernia can happen to men and/or women of all ages. In adults, the tissue is weakened (from infection, a previous operation, obesity, smoking) and then any strain (from lifting, coughing, etc.) can result in a hernia.

Although any part of the abdominal wall can rupture, the majority of hernias occur in the groin -- inguinal hernia; through the belly button -- umbilical hernia; and through a previous surgical scar -- incisional hernia.

Treatment

Hernias are repaired with an operation. A hernia will not go away with time; it will not improve with exercise or medications. Under certain circumstances, the hernia could be watched and followed closely by a physician, but nearly all hernias need to be surgically repaired. Delaying repair can result in incarceration (the contents of the hernia get caught in the hernia) or strangulation (the contents can get squeezed and the blood supply is cut off resulting in gangrene) the hernia then becomes a surgical emergency.

There are actually 7 recognized methods to repair hernias. With one exception, a synthetic mesh is used to "patch" the defect. The mesh is placed to cover the defect by making an incision directly over the hernia (the open repair) or it is placed from inside the abdomen using tiny incisions and a laparoscope (the laparoscopic repair) the laparoscopic repair is also called the minimally invasive repair.

laparoscopic

Laparoscopic Repair

Why don't more surgeons repair hernias with the laparoscope?

Only about 10% of all surgeons who repair hernias (General Surgeons) use the laparoscope to place the mesh and patch the defect. This repair is difficult to learn (a recent study concluded 200 laparoscopic operations were required for expertise) but worth the effort.

How is a laparoscopic hernia repair performed?

Laparoscopic surgery is performed by inserting a long thin scope with a camera attached at one end through a small incision near the navel. Two other tiny incisions are made and the abdomen is inflated with carbon dioxide (CO2) to give better visibility. The mesh is used to patch the hernia (hole) from the inside. This allows repair of the defect without tension. The repair is performed using general anesthesia.

What do I need to know before my operation?

This is, almost every time, an outpatient procedure. If the hernia is quite large or complicated, you must require an overnight hospital stay (more than 90% of cases are outpatient)

If you smoke, it will be very beneficial for you to stop at least two weeks before your operation.

Excessive lifting before the operation should be avoided.

Dr. Redd will want to make sure you have had your questions answered and the procedure fully explained.

You will be given a pre-operation and a post-operation instruction sheet.

What complications can occur?

Any surgical procedure may be associated with complications. The primary complications of any operation are bleeding and infection, which are both uncommon with a laparoscopic repair.

There is a slight risk of:

Recurrence -- Any time a hernia is repaired, it can come back. Following post-operation instructions can decrease your risk of recurrence.

Injury to surrounding structures -- The intestines, bladder, blood vessels, nerves, spermatic duct are at risk because of proximity.

Difficult/delayed urination -- This is usually a self-limited problem that revolves with time but it can involve placing a temporary catheter.

Which repair is best?

It has been correctly said, "the best hernia repair is the one your surgeon does the best." All seven repairs have been performed with a recurance rate of less than one out of 100 (< 1%), but they each have their advantages and disadvantages. Dr. Redd believes the laparoscopic repairs offer more benefits:

  • Usually 3 tiny scars versus one large abdominal incision
  • Reduced post-operation pain
  • Faster return to work or activity
  • Shorter recovery time
  • Ability to see and repair other hernias and/or other problems