A hernia can occur when the tough lining of the abdomen, known as the fascia, weakens, allowing abdominal contents to push through. The intestine, colon, or fat tissue may then pass through the hernia defect. Hernias can be very disruptive for some, while others will never know they have one. It is important to note that hernias are a progressive disorder, meaning they do not improve independently. While many hernia belts or other devices claim to improve hernias non-surgically, this has not been proven to be effective. Indeed, the only proven solution to a hernia is surgical repair.
One of the most commonly performed, minimally invasive surgical procedures in the United States is hernia repair. Approximately 1 million hernias are repaired annually, with about 75% of those inguinal or groin hernias. Inguinal hernias affect men far more than women. Other hernias include incisional (from surgery), umbilical (belly button), and femoral (thigh). The risk of serious complications varies depending on the location of the hernia. For example, inguinal hernias have about a 1 to 2% chance of serious complications, while femoral hernias may have up to a 20% chance.
The Symptoms of a Hernia
Hernias can be extremely painful. On the other hand, many patients will never be aware that they have one. When a hernia becomes symptomatic and interferes with the patient’s lifestyle, it should be corrected soon to avoid additional complications. The pain associated with a hernia can start as mild, but if left untreated, it can quickly escalate. This is especially true if the hernia contents become incarcerated, meaning they cannot be pushed back into the abdomen. The worst-case scenario is strangulation, where the incarcerated hernia loses blood flow, and tissue begins to die. This emergency requires an immediate trip to the ER and is generally associated with less favorable surgical outcomes.
It is important to note that severe hernias may not present with commensurate pain. For example, small hernias may be very painful, while larger hernias may only present with mild discomfort. As a result, it is essential to visit your primary care physician or general surgeon to get a proper diagnosis and understand more about the particulars of your hernia.
How is a Hernia Repair Performed?
Hernia repair is a straightforward procedure; however, allowing the hernia to grow makes surgery more complex. The patient may be more susceptible to complications and recurrence in these cases.
Specialized, robotically assisted miniature surgical devices are inserted into the stomach, including a high-definition camera known as a laparoscope. First, we will reduce the hernia by removing the abdominal contents from the defect. We will cover the defect using self-adhering surgical mesh without requiring suturing to close it. This non-tension repair significantly reduces the risk of recurrence. Over the next few weeks, the body will grow scar tissue over the mesh, creating a solid barrier.
Most of our hernia repairs are performed using minimally invasive robotic surgical technology, which reduces pain, blood loss, and recovery time. Certain patients will require an open hernia repair, which can be determined after a thorough evaluation and consultation with our office.
For the most part, repairs are performed in an outpatient surgery setting; however, some cases may require an overnight stay. Much like any other surgical procedure, hernia repair carries risks, especially if the hernia is large or if it is a recurrence. Patients should discuss the benefits and risks of this surgery with our office.
What about chronic pain after inguinal hernia repair?
If you’ve researched inguinal hernias, you may have come across a common complaint about chronic pain. This issue has been primarily addressed through advancements in technique and technology. We pay special attention to the nerve bundles in the groin area during dissection, being sure to use blunt dissection rather than sharp cutting tools. Further, today’s hernia mesh is lighter and customized to the patient’s anatomy. Finally, the self-adhering mesh has eliminated the need for titanium or absorbable tacks, which in the past would have potentially injured or irritated nerves in the area. It is also important to note that the pain level before the hernia procedure often indicates the level of pain a patient will experience afterward. Therefore, we usually suggest that patients proactively have their hernia repaired even if it is not causing significant pain.
Is Surgery Always Necessary?
Typically, if a hernia is found incidentally and is not symptomatic, we do not suggest that it be repaired. For symptomatic hernias, younger patients are ideal candidates for surgery, as their surgical risk is relatively low, and their chance of complications, including strangulation, is significantly higher than that of older patients. However, patients of advanced age may have more leeway in determining whether they wish to proceed with a hernia repair. The weakened musculature of the abdomen due to their age means that strangulation is less likely. However, this same characteristic may also allow the hernia defect to grow faster.
During your consultation with us, you will discuss the pros and cons of undergoing hernia surgery and make an informed decision accordingly.