Hernia Surgery

What is a Hernia?

In simple terms, a hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. Think of it like a bulge or a sac. While hernias can occur in various parts of the body, abdominal wall hernias are the most common, involving the muscles of your abdomen.

How are Hernias Formed?

Hernias typically form due to a combination of two factors:

  • Pre-existing Weakness: Some individuals are born with naturally weaker areas in their abdominal wall.

  • Increased Pressure: Activities or conditions that put strain on the abdominal wall can cause tissue to push through these weak spots. This pressure can come from:

    • Lifting heavy objects

    • Chronic coughing or sneezing

    • Straining during bowel movements or urination

    • Pregnancy

    • Obesity

    • Fluid in the abdomen (ascites)

Over time, this repeated pressure on a weak spot can lead to the formation of a hernia.

Types of Abdominal Wall Hernias

While all abdominal wall hernias involve a protrusion through a weakened area, their classification often depends on their location:

  • Ventral Hernias: These occur in the front of the abdomen. They can be:

    • Epigastric: Above the belly button.

    • Umbilical: At or near the belly button (common in infants, but can also occur in adults).

    • Incisional: Developing at the site of a previous surgical incision, where the scar tissue may be weaker.

  • Inguinal Hernias: The most common type of hernia, occurring in the groin area. They happen when a part of the intestine or fat pushes through a weak spot in the lower abdominal wall.

  • Femoral Hernias: Less common than inguinal hernias, these occur in the upper thigh, just below the groin. They are more prevalent in women due to the wider bone structure of the pelvis.

  • Spigelian Hernias: A rarer type of hernia that occurs along the edge of the rectus abdominis muscle, often difficult to diagnose due to their location.

What Symptoms Do Hernias Cause?

The symptoms of a hernia can vary depending on its size and location, but commonly include:

  • A Visible Bulge: This is often the most noticeable symptom, especially when standing, coughing, or straining. The bulge may disappear when you lie down.

  • Pain or Discomfort: This can range from a dull ache to sharp pain, especially when engaging in activities that increase abdominal pressure.

  • A Feeling of Heaviness or Dragging: In the area of the bulge.

  • Burning or Aching Sensation: At the site of the hernia.

When to Seek Immediate Medical Attention:

While most hernias are not immediately life-threatening, certain symptoms require urgent medical care. These indicate a strangulated hernia, where the trapped tissue loses its blood supply, and include:

  • Sudden, severe pain that worsens rapidly.

  • Nausea and vomiting.

  • Fever.

  • Redness or discoloration of the bulge.

  • The bulge becoming firm, tender, and not able to be pushed back in (irreducible).

If you experience any of these symptoms, please go to the emergency room immediately.

Will a Hernia Get Better Without Surgery?

In almost all cases, no, a hernia will not get better on its own. Once a hernia forms, the weakened tissue will not naturally repair itself. In fact, most hernias tend to enlarge over time and can cause increasing discomfort or lead to more serious complications like strangulation.

While some very small hernias might be monitored, surgical repair is generally recommended to prevent progression and complications.

Surgical Repair Techniques

Hernia repair surgery aims to push the protruding tissue back into place and reinforce the weakened abdominal wall. The three primary surgical approaches are:

  • Open Hernia Repair:

    • This is the traditional method.

    • The surgeon makes a single incision near the hernia site.

    • The protruding tissue is gently pushed back into the abdomen.

    • The weakened muscle or tissue is then sewn together, often with the placement of a mesh for reinforcement.

  • Laparoscopic Hernia Repair (Minimally Invasive):

    • This technique involves several small incisions (usually 3-4) rather than one large one.

    • A thin, lighted telescope (laparoscope) with a camera is inserted through one incision, allowing the surgeon to view the internal organs on a monitor.

    • Specialized surgical instruments are inserted through the other small incisions to perform the repair.

    • Mesh is commonly used in laparoscopic repairs to strengthen the abdominal wall.

  • Robotic Hernia Repair:

    • Similar to laparoscopic surgery, robotic repair also uses small incisions and a camera to visualize the surgical field.

    • However, the surgeon controls robotic arms that manipulate the surgical instruments. These robotic arms offer enhanced dexterity, a greater range of motion, and a magnified, high-definition 3D view of the surgical area.

    • This advanced precision can be particularly beneficial for complex hernias or when working in tight anatomical spaces.

    • Mesh is also typically used in robotic hernia repairs.

Advantages of Minimally Invasive Approaches (Laparoscopic and Robotic):

  • Smaller incisions, leading to less scarring.

  • Potentially less post-operative pain.

  • Faster recovery time and return to normal activities.

  • Robotic-specific advantage: Enhanced precision and visualization for the surgeon.

Your surgeon will discuss which approach is best suited for your specific hernia and overall health.

What is Surgical Mesh?

Surgical mesh is a medical device used to provide support and reinforce weakened tissue, particularly in hernia repairs. It's typically made from synthetic materials (like polypropylene) or, less commonly, from animal tissue.

How does Mesh Work?

The mesh acts as a scaffolding, providing a strong, permanent layer over the repaired weak spot. Over time, your body's own tissue grows into and around the mesh, integrating it into the abdominal wall and providing long-term strength to prevent recurrence.

Is Mesh Always Used?

While mesh is very commonly used due to its effectiveness in reducing recurrence rates, there are certain situations where a "tissue repair" (without mesh) might be considered, particularly for smaller hernias or in specific patient circumstances. Your surgeon will discuss the pros and cons of mesh use for your individual case.

What are the Risks of Surgery?

As with any surgical procedure, hernia repair carries potential risks, though serious complications are rare. Your surgeon will discuss these in detail during your consultation. Potential risks include:

  • Infection: At the surgical site.

  • Bleeding: During or after surgery.

  • Pain: Post-operative pain is expected but can sometimes be persistent.

  • Recurrence: Although mesh reduces the risk, a hernia can sometimes recur, requiring further surgery.

  • Nerve Damage: Leading to numbness or chronic pain in the area.

  • Damage to Surrounding Organs: (Rare) intestines, bladder, or blood vessels.

  • Adverse Reaction to Anesthesia:

  • Mesh-related Complications: While rare, these can include chronic pain, infection of the mesh, or mesh erosion (where the mesh moves or causes issues with surrounding tissue).

What is the Recovery After Surgery?

Recovery after hernia surgery varies depending on the type of repair (open vs. laparoscopic vs. robotic), the size and location of the hernia, and your overall health.

General Expectations:

  • Immediately After Surgery: You will be monitored in a recovery area. You may experience some pain, swelling, and bruising at the incision sites.

  • Pain Management: You will be prescribed pain medication to manage discomfort.

  • Activity: You will be encouraged to get up and walk around soon after surgery to promote circulation and prevent complications.

  • Diet: You can typically resume a regular diet as tolerated.

  • Restrictions:

    • Lifting: You will have restrictions on heavy lifting for several weeks to allow the repair to heal. Your surgeon will provide specific guidelines.

    • Straining: Avoid activities that cause straining, such as constipation or vigorous coughing.

    • Driving: You may be advised to avoid driving for a few days to a week, especially if you are taking strong pain medication.

  • Return to Work/Normal Activities:

    • Laparoscopic and Robotic Repair: Many patients can return to light activities and office work within a few days to a week.

    • Open Repair: Recovery may take a bit longer, typically 2-4 weeks for light activities.

    • Full recovery and return to strenuous activities may take 6 weeks or more.

  • Follow-up: You will have a follow-up appointment with your surgeon to assess your recovery and answer any further questions.

Important Post-Operative Care:

  • Keep Incisions Clean and Dry: Follow your surgeon's instructions for wound care.

  • Watch for Signs of Complication: Contact your surgeon if you experience increasing pain, redness, swelling, fever, or pus from the incision.

  • Listen to Your Body: Don't push yourself too hard during recovery. Gradual increase in activity is key.